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Survey about allergy, winter, family, loans, hiv and relatives.

Begin Survey

1. Do you have any piercings? Yes No

2. Do you have a DVD player? Yes No

3. Do you have a sit-down family dinner every night? Yes No

4. Do you smoke cigarettes? Yes No

5. Do you know how to fly an airplane? Yes No

6. Will you engage in rigorous physical activity at least three times this week? Yes No

7. Have you ever broken any bones? Yes No

8. Would you consider yourself an avid sports fan? Yes No

9. Do you have any food allergies? Yes No

10. Do you enjoy cooking or baking? Yes No

11. Do you speak any foreign languages? Yes No

12. Do enjoy reading or writing poetry? Yes No

13. Do you get a flu shot every winter? Yes No

14. Have you ever been tested for HIV? Yes No

15. Do you have or use a PDA (Personal Digital Assistant)? Yes No

16. Have you ever borrowed money from a relative? Yes No

17. Are your immunizations up-to-date? Yes No

18. Would you like a free video or CD-ROM with more information on owning or renting an RV? Yes No

Your Firstname:

Your Emailaddress:

Yes, I would like to join the Daily Life Survey!

Fun and Interesting facts: - Al Capone's business card said he was a used furniture dealer. - The onion is named after a Latin word meaning large pearl. - Betty Rubble made her debut as a Flintstones Vitamin in 1996. - In Washington D.C., no building may be built taller than the Washington Monument.

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