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Survey about phobias, religion, restaurants, cacoa, family and trains.

Begin Survey

1. Do you drink diet soda? Yes No

2. Do you enjoy classical music? Yes No

3. Will you take any train or subway rides this week? Yes No

4. Have you ever been arrested? Yes No

5. Do you attend regular religious services? Yes No

6. Do you have an annual check-up or exam with your family doctor? Yes No

7. Do you give your children a daily multi-vitamin? Yes No

8. Do you have any phobias? Yes No

9. Do you brush your teeth before bed each night? Yes No

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

11. Have you ever traced your family tree? Yes No

12. Will you order take-out or delivery food from a restaurant this week? Yes No

13. Do you have or use a cellular phone? Yes No

14. Have you eaten fast food this week? Yes No

15. Do you enjoy Girl Scout cookies? Yes No

16. 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: - Albert Einstein was offered the presidency of Israel in 1952 (he declined). - A cup of coffee has 12 times the amount of caffeine as a cup of cocoa. - Women blink nearly twice as much as men. - The world's largest art gallery is the Winter Palace and Hermitage in St. Petersburg, Russia.

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