| Nationality: |
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| Country of Residence: |
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| Age Range: |
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| Profession: |
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| Passion(s): |
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| Name a country where you've experienced cultural differences: |
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| Describe one of those experiences: |
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| What did you learn about your own culture from that experience? |
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| If you were going to adopt a custom, gesture or trait from another culture, what would it be? |
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| Where would you like your next culture crossing adventure to take you? |
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| My personal experience includes: |
| Traveling to: |
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