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Survey about smoking, hiv, camping, latte, cigarettes and charlie chaplin.

Begin Survey

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

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

3. Are you involved in volunteerism? Yes No

4. Do you know your cholesterol level? Yes No

5. Do you have any pets? Yes No

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

7. Do you ever download music from the Internet? Yes No

8. Do you shower at least once daily? Yes No

9. Do you wear sandals/flip-flops in the summer? Yes No

10. Do you eat lunch every day? Yes No

11. Do you plan on taking a trip by airplane this week? Yes No

12. Do you attend regular religious services? Yes No

13. Do you smoke cigarettes? Yes No

14. Will you buy an espresso drink (cappuccino, latte etc.) from a coffee house this week? Yes No

15. Do you have any camping trips planned for this summer? Yes No

16. Will you visit a doctor this week? Yes No

17. Have you ever spent more than $100 on a pair of shoes? Yes No

18. 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: - Charlie Chaplin once won third prize in a Charlie Chaplin look alike contest. - The fortune cookie was invented in 1916 by George Jung, a Los Angeles noodlemaker. - The little lump of flesh just forward of the ear canal, right next to the temple, is called a tragus. - The world's largest art gallery is the Winter Palace and Hermitage in St. Petersburg, Russia.

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