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Survey about birth, bungee-jumping, attractive, arizona, work and four corners.

Begin Survey

1. Do you eat breakfast every morning? Yes No

2. Do you plan on performing any community service this week? Yes No

3. Would you consider yourself to be in good overall health? Yes No

4. Have you ever gone sky-diving or bungee-jumping? Yes No

5. Do you believe in karma? Yes No

6. Are your parents still married? Yes No

7. Do you have health insurance? Yes No

8. Do you follow a low-carb diet? Yes No

9. Do you brush your teeth each morning? Yes No

10. Will you order take-out or delivery food from a restaurant this week? Yes No

11. Do you wear sunscreen every day? Yes No

12. Do you take a bagged lunch to work every day? Yes No

13. Have you ever broken any bones? Yes No

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

15. Can you roller-skate, roller-blade, and/or ice-skate? Yes No

16. Do you think you are physically attractive? Yes No

17. Have you ever been less than honest on your income tax return? Yes No

18. Do you believe in love at first sight? Yes No

19. Do you like peanut butter and jelly sandwiches? Yes No

20. Do you shower at least once daily? Yes No

21. 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: - Frank Sinatra never wore or owned a pair of blue jeans. - A cup of coffee has 12 times the amount of caffeine as a cup of cocoa. - After the age of 35, about 1 in 27 women will give birth to twins. After 50, the chances of having twins is 1 in 9. - The only place in the US where four states intersect at a single point is called Four Corners. The four states are Utah, New Mexico, Colorado, and Arizona.

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