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Survey about mouthwash, malls, coffee, coffeine, dead and cacoa.

Begin Survey

1. Do you have any piercings? Yes No

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

3. Do you enjoy documentary films? Yes No

4. Do you read your horoscope every day? Yes No

5. Do you use charge cards? Yes No

6. Do you have any pets? Yes No

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

8. Do you plan on taking a trip by airplane this week? Yes No

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

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

11. Do you use mouthwash? Yes No

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

13. 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. - A cup of coffee has 12 times the amount of caffeine as a cup of cocoa. - Only 1 person in 2 billion will live to be 116. - 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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