ME

1. What is my full name?

Amelia Nicole Warner Emily Marie Warner Emily Nicole Warner Amelia Marie Warner

2. What did I lose?

laptop cellphone nintendo Ds Nothing

3. When is my birthday?

October, 12 1996 October, 11,1997 October, 11, 1995 October, 11, 1996

4. Who is my celebrity crush?

Joe Jonas Nat Wolff Ryan Sheckler B and C

Your name

E-mail address

HTML Code

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  <div style="width: 100%;">    
  <h1 style="color: #376e93;">ME </h1>
         
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>What is my full name?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9802]" value="A" /> Amelia Nicole Warner</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9802]" value="B" /> Emily Marie Warner</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9802]" value="C" /> Emily Nicole Warner</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9802]" value="D" /> Amelia Marie Warner</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>What did I lose?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9803]" value="A" /> laptop</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9803]" value="B" /> cellphone</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9803]" value="C" /> nintendo Ds</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9803]" value="D" /> Nothing</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>When is my birthday?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9804]" value="A" /> October, 12 1996</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9804]" value="B" /> October, 11,1997</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9804]" value="C" /> October, 11, 1995</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9804]" value="D" /> October, 11, 1996</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>Who is my celebrity crush?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9805]" value="A" /> Joe Jonas</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9805]" value="B" /> Nat Wolff</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9805]" value="C" /> Ryan Sheckler</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[9805]" value="D" /> B and C</label>
      <br />     
      <div><label for="userName">Your name</label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
      <input type="text" name="userName" id="userName" value="" style="width: 300px;" />     
    </div><br />
    <div>
      <label for="userEmail">E-mail address</label>
      <input type="text" name="userEmail" id="userEmail" value="" style="width: 300px;" />     
    </div><br />
    	<input type="submit" name="submit" value="Ready" /> <span style="margin-left: 200px;">powered by: <a href="http://www.flufo.com" target="_blank">flufo.com</a></span>
  </div>
</form>

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