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Survey about diet soda, pizza, teeth, online banking, blue jeans and money.

Begin Survey

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

2. Will you use a coupon for any of your purchases this week? Yes No

3. Do you use online banking? Yes No

4. Have you ever been arrested? Yes No

5. Have you ever participated in a focus group? Yes No

6. Do you give your children a daily multi-vitamin? Yes No

7. Will you buy a lottery ticket this week? Yes No

8. Do you contribute money to any charitable organizations? Yes No

9. Do you drink diet soda? Yes No

10. Have you ever broken any bones? Yes No

11. Do you own at least one pair of blue jeans? Yes No

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

13. Do you have a VCR? Yes No

14. Do you know your cholesterol level? Yes No

15. Are you a registered voter? 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: - Al Capone's business card said he was a used furniture dealer. - Approximately 3 billion pizzas are sold in the U.S. each year. - You are more likely to get attacked by a cow than a shark. - There are 365 steps on the front of the U.S. Capitol Building - one for every day of the year.

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