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Survey about medications, seed, first aid, languages, ho-ho-kus and athletes.

Begin Survey

1. Do you have any pets? Yes No

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

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

4. Do you enjoy roller coasters? Yes No

5. Will you be staying at a hotel this week? Yes No

6. Do you take a bagged lunch to work every day? Yes No

7. Do you have a land-line phone in your home? Yes No

8. Do you suffer from seasonal allergies? Yes No

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

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

11. Do you have a retirement investment account (401k, IRA, etc.)? Yes No

12. Do you subscribe to your local newspaper? Yes No

13. Do you splash in mud puddles? Yes No

14. Do you have a VCR? Yes No

15. Do you speak any foreign languages? Yes No

16. Do you have any piercings? Yes No

17. Do you own a first aid kit? Yes No

18. Do you think you are intelligent? Yes No

19. Do you enjoy documentary films? Yes No

20. Do you enjoy board games? 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: - Houdini was the first man to fly a plane solo in Australia. - The coconut is the largest seed in the world. - It takes 17 muscles to smile, 43 to frown. - Ho-Ho-Kus, a small town in New Jersey, is the only town in the United States of America that has two dashes in its name.

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