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Survey about medications, xbox, coffee house, religion, television and comics.

Begin Survey

1. Do you own a console video game system (Xbox, Playstation 2, GameCube, etc.)? Yes No

2. Do you attend regular religious services? Yes No

3. Do you enjoy watching cooking shows? Yes No

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

5. Do you plan on visiting a mall this week? Yes No

6. Will you buy an espresso drink (cappuccino, latte etc.) from a coffee house this week? Yes No

7. Do you enjoy reality television? Yes No

8. Would you consider yourself an avid sports fan? Yes No

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

10. Do you read the comics? Yes No

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

12. Have you ever had a professional massage? Yes No

13. Do you drink diet soda? Yes No

14. 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: - Oil tycoon John D. Rockefeller was the world's first billionaire. - Tootsie Rolls were the first wrapped penny candy in America. - The tongue is the strongest muscle in the human body. - The world's largest art gallery is the Winter Palace and Hermitage in St. Petersburg, Russia.

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