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Survey about pillow, smoking, charcoal briquette, stores, allergy and hawaii.

Begin Survey

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

2. Do you have any food allergies? Yes No

3. Do you smoke cigarettes? Yes No

4. Do you always wear your safety belt when in a car? Yes No

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

6. Will you go to the grocery store this week? Yes No

7. Have you ever traveled by airplane? Yes No

8. Have you ever been rock or mountain climbing? Yes No

9. Do you use mouthwash? Yes No

10. Will you visit a beauty salon this week? Yes No

11. Will you visit a hardware or home improvement store this week? Yes No

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

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

14. Do you know CPR? Yes No

15. Do you ever download movies from the Internet? 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: - Henry Ford, father of the assembly line, also invented the charcoal briquette. - Nutmeg is extremely poisonous if injected intravenously. - Men are 6 times more likely to be struck by lightning than women. - Hawaii has the only royal palace in the United States – Iolani.

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