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Survey about health, fortune cookies, heart rate, road rage, poetry and allergy.

Begin Survey

1. Do you have any camping trips planned for this summer? Yes No

2. Do you think you are intelligent? Yes No

3. Have you ever taken dance lessons? Yes No

4. Do enjoy reading or writing poetry? Yes No

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

6. Are any of your grandparents still alive? Yes No

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

8. Will you visit a hardware or home improvement store this week? Yes No

9. Do you have road rage? Yes No

10. Do you have any food allergies? Yes No

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

12. Have you ever purchased or sold anything on eBay? Yes No

13. Do you speak any foreign languages? Yes No

14. Did you vote in the last Presidential election? Yes No

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

16. Have you ever been arrested? Yes No

17. Do you have Internet access at home? Yes No

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

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

20. Are you involved in volunteerism? Yes No

21. 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: - Mr. Rogers was an ordained minister. - The fortune cookie was invented in 1916 by George Jung, a Los Angeles noodlemaker. - Your heart rate can rise as much as 30% during a yawn. - Built in 1763, Touro Synagogue in Newport, Rhode Island, is the oldest surviving synagogue in North America.

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