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Survey about night clubs, teeth, coupons, checking account, health and driving.

Begin Survey

1. Can you drive a stick shift? Yes No

2. Do you have any phobias? Yes No

3. Do you work outside of the home? Yes No

4. Do you wear mittens? Yes No

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

6. Are your immunizations up-to-date? Yes No

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

8. Do you smoke cigarettes? Yes No

9. Do you brush your teeth each morning? Yes No

10. Do you use online banking? Yes No

11. Do you have a checking account? Yes No

12. Will you go to a bar or night club this week? Yes No

13. Do you own or use a digital camera? Yes No

14. Do you plan on visiting the public library this week? Yes No

15. Do you know your cholesterol level? Yes No

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

17. Do you enjoy card games? Yes No

18. Do you belong to any professional organizations? Yes No

19. Do you use a dishwasher to do your dishes? Yes No

20. 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.) - The candy bar 'Baby Ruth' was named after the daughter of U.S. President Grover Cleveland in 1921. - 15% of Americans secretly bite their toes. - There are 365 steps on the front of the U.S. Capitol Building - one for every day of the year.

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