welcome to my life

1. what am i most self-conscious about?

weight height laugh friends

2. what song do i want played at my funeral?

the best days by graham colton time of my life by david cook it's not my time by 3 doors down pocketfull of sunshine by natasha bedingfield

3. who do i plan on naming my kids after?

the cullens from twilight the bird kids from maximum ride my brother and my sister nobody

4. when is my birthday?

july 28th march 10th february 8th september 15th

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  <h1 style="color: #376e93;">welcome to my life </h1>
         
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>what am i most self-conscious about?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11131]" value="A" /> weight</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11131]" value="B" /> height</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11131]" value="C" /> laugh</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11131]" value="D" /> friends</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>what song do i want played at my funeral?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11132]" value="A" /> the best days by graham colton</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11132]" value="B" /> time of my life by david cook</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11132]" value="C" /> it&#039;s not my time by 3 doors down</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11132]" value="D" /> pocketfull of sunshine by natasha bedingfield</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>who do i plan on naming my kids after?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11133]" value="A" /> the cullens from twilight</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11133]" value="B" /> the bird kids from maximum ride</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11133]" value="C" /> my brother and my sister</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11133]" value="D" /> nobody</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>when is my birthday?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11134]" value="A" /> july 28th</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11134]" value="B" /> march 10th</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11134]" value="C" /> february 8th</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[11134]" value="D" /> september 15th</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;" />     
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    	<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>
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