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Survey about women, men, road trips, roller coasters, poetry and personal ads.

Begin Survey

1. Will you be taking any road trips this week (over 50 miles)? Yes No

2. Do you like chocolate? Yes No

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

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

5. Do you enjoy roller coasters? Yes No

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

7. Will you engage in rigorous physical activity at least three times this week? Yes No

8. Will you attend religious services this week? Yes No

9. Have you ever been less than honest on your income tax return? Yes No

10. Have you ever placed a personals ad? Yes No

11. Have you ever gotten a traffic ticket? Yes No

12. Have you ever borrowed money from a relative? Yes No

13. Do you run the vacuum (or sweep) your floors every day? Yes No

14. Will you go see a new-release movie at a theater this week? Yes No

15. Do you follow a vegetarian diet? Yes No

16. Are you married? Yes No

17. Can you whistle? Yes No

18. Do you take any prescribed daily medications? Yes No

19. Do enjoy reading or writing poetry? Yes No

20. Do you eat lunch every day? Yes No

21. 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: - Walt Disney named Mickey Mouse after Mickey Rooney, whose mother he dated for some time. - The average French citizen eats 500 snails per year. - Men are 6 times more likely to be struck by lightning than women. - The Great Wall stretches for about 4,500 miles across North China.

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