From the April 1945 magazine.

Big Light Can Be Shed on Alcoholism If A.A.s Fill This in and Return to Grapevine

The purpose of this questionnaire is to ascertain at what age the incidents or experiences listed below first happened. The order in which they are set down may not accord with your own experience, but please fill in the year after the item anyway. If you never had a particular experience, leave the space blank. The samples are intended to be suggestive only and are in no way definitive.

AT WHAT AGE DID YOU FIRST: AGE

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