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Survey about cologne, psychiatrists, medications, milk, jimmy carter and therapists.

Begin Survey

1. Do you drink milk? Yes No

2. Do you attend regular religious services? Yes No

3. Have you ever been in a car accident? Yes No

4. Will you take any train or subway rides this week? Yes No

5. Do you wear cologne or perfume every day? Yes No

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

7. Do you read the comics? Yes No

8. Do you have a checking account? Yes No

9. Do you have a savings account? Yes No

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

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

12. Will you visit a therapist or psychiatrist this week? Yes No

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

14. Do you splash in mud puddles? Yes No

15. Do you fly an American flag at home? Yes No

16. Will you visit a beauty salon this week? Yes No

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

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

19. Have you ever been arrested? Yes No

20. 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: - Jimmy Carter is the first U.S. President to have been born in a hospital. - Dandelion root can be roasted and ground as a coffee substitute. - Men are 6 times more likely to be struck by lightning than women. - In Washington D.C., no building may be built taller than the Washington Monument.

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