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Survey about phobias, cigarettes, ethnic foods, hiv, muscles and smoking.

Begin Survey

1. Do you smoke cigarettes? Yes No

2. Do you enjoy reality television? Yes No

3. Do you have any phobias? Yes No

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

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

6. Are you left-handed? Yes No

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

8. Have you ever been arrested? Yes No

9. Do you have or use an MP3 player? Yes No

10. Do you enjoy ethnic foods? Yes No

11. Will you go to a concert this week? Yes No

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

13. Do you watch the evening news? Yes No

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

15. 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: - Frank Sinatra never wore or owned a pair of blue jeans. - Non-dairy creamer is flammable. - It takes 17 muscles to smile, 43 to frown. - The world's largest art gallery is the Winter Palace and Hermitage in St. Petersburg, Russia.

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