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Survey about spicy food, doctor, woman, chocolate, independent films and luck.

Begin Survey

1. Do you follow a vegetarian diet? Yes No

2. Do you have any phobias? Yes No

3. Do you have any food allergies? Yes No

4. Do you drink diet soda? Yes No

5. Will you consume any alcoholic beverages this weekend? Yes No

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

7. Do you plan on visiting a comedy club this month? Yes No

8. Do you own at least one pair of blue jeans? Yes No

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

10. Will you be visiting any theme parks this year? Yes No

11. Have you ever won the lottery? Yes No

12. Do you like chocolate? Yes No

13. Do you wear cologne or perfume every day? Yes No

14. Have you ever broken any bones? Yes No

15. Do you enjoy spicy foods? Yes No

16. Do you enjoy independent films? Yes No

17. Do you have any pets? Yes No

18. Are you married? Yes No

19. 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: - Jackie Kennedy Onassis was secretly a chain smoker. - Dandelion root can be roasted and ground as a coffee substitute. - 80% of people over 100 years old are women. - Space Needle in Seattle, built for the 1962 Worlds Fair, is home to the Nations first Monorail, which is still in operation.

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