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Survey about coffee, golden gate bridge, beans, safety belt, passports and life.

Begin Survey

1. Do you have a valid passport? Yes No

2. Do you have any food allergies? Yes No

3. Do you believe there is life on other planets? Yes No

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

5. Do you have any pets? Yes No

6. Have you ever been rock or mountain climbing? Yes No

7. Will you visit a doctor this week? Yes No

8. Do you have a DVD player? Yes No

9. Do you always wear your safety belt when in a car? Yes No

10. Have you ever been arrested? Yes No

11. Did you drink coffee this morning? Yes No

12. Have you ever pilfered office supplies from work? Yes No

13. Do you think professional athletes should be regularly screened for illicit drug use? Yes No

14. Do you take a daily multi-vitamin? Yes No

15. 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. - Lima beans contain cyanide. - Hailed as a wonder drug in the late nineteenth century, cocaine was outlawed in the United States in 1914. - The Golden Gate Bridge was first opened in 1937.

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