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Survey about cappuccino, coffee substitute, dandelion root, health, bungee-jumping and take-out.

Begin Survey

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

2. Will you buy an espresso drink (cappuccino, latte etc.) from a coffee house this week? Yes No

3. Do you belong to any professional organizations? Yes No

4. Will you rent a DVD or video this weekend? Yes No

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

6. Have you ever gotten a traffic ticket? Yes No

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

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

9. Will you go to a bar or night club this week? Yes No

10. Do you wear mittens? Yes No

11. Do you brush your teeth before bed each night? Yes No

12. Do you have or use a cellular phone? Yes No

13. Do you enjoy card games? Yes No

14. Do you plan on visiting the public library this week? Yes No

15. Should government employees be randomly tested for illicit drug use? Yes No

16. Are you involved in volunteerism? Yes No

17. Do you work outside of the home? Yes No

18. Are you a veteran? Yes No

19. 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: - Of the six men who made up the Three Stooges, three of them were real brothers (Moe, Curly and Shemp.) - Dandelion root can be roasted and ground as a coffee substitute. - Between 25% to 33% of people sneeze when they are exposed to light. - Hawaii has the only royal palace in the United States – Iolani.

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