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Survey about blueberry jelly, phobias, coca-cola, team sports, new jersey and soft drinks.

Begin Survey

1. Do you take any prescribed daily medications? Yes No

2. Do you practice yoga? Yes No

3. Do you have a VCR? Yes No

4. Do you ever dye your hair? Yes No

5. Do you wear a watch every day? Yes No

6. Are you satisfied in your current employment? Yes No

7. Have you ever cut your own hair? Yes No

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

9. Do you enjoy card games? Yes No

10. Do you believe in Santa Claus? Yes No

11. Do you sleep with a pillow at night? Yes No

12. Do you play any organized team sports? Yes No

13. Do you have any phobias? Yes No

14. Will you consume any alcoholic beverages this weekend? Yes No

15. Do you own a first aid kit? Yes No

16. 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: - Blueberry Jelly Bellies were created especially for Ronald Reagan. - Coca-Cola was the first soft drink to be consumed in outer space. - More children are allergic to cockroaches than cats - Ho-Ho-Kus, a small town in New Jersey, is the only town in the United States of America that has two dashes in its name.

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