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Survey about movies, santa claus, thesaurus, insurance plans, sporting events and income tax.

Begin Survey

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

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

3. Have you ever been in a tornado, earthquake, or other natural disaster? Yes No

4. Do you splash in mud puddles? Yes No

5. Have you ever been less than honest on your income tax return? Yes No

6. Do you own a dictionary and/or thesaurus? Yes No

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

8. Have you ever been arrested? Yes No

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

10. Do you believe in Santa Claus? Yes No

11. Will you visit a therapist or psychiatrist this week? Yes No

12. Will you attend a professional sporting event this month? Yes No

13. Do you have any piercings? Yes No

14. Have you ever placed a personals ad? Yes No

15. Do you enjoy science fiction/fantasy movies? Yes No

16. Do you own a boat, camper, or other recreational vehicle? Yes No

17. Do you follow a low-carb diet? Yes No

18. Do you sleep with a pillow at night? Yes No

19. 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: - Of the six men who made up the Three Stooges, three of them were real brothers (Moe, Curly and Shemp.) - At one time, pumpkins were recommended for removing freckles. - Club Direct, a travel insurance company in Britain, provides insurance plans for protection from falling coconuts. - The world’s first gas station was opened by the Gulf Refining Company on December 1, 1913, in Pittsburgh, Pennsylvania.

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