How well do you know me

1. When is my birthday

Dec 6 Dec 8 Dec 28 Dec 25

2. What's my favorite cocktail?

goose soda stoli soda kettle soda absolute soda

3. What floor is my apartment on?

5th 9th 6th 4th

4. favorite food

chimichangas noodles clams french fries

5. I have ____ rooms in my apartment

5 4 3 6

6. My grandpa's name

Bill Jim Tex Andy

7. Last concert I went to?

The killers My chemical romance Bad Religion STP

8. I used to go to work drunk every_______..

Tuesday day dammit! Sunday Thursday

9. I still haven't

sky dived bought a lottery ticket been to Europe made a friend in Japan

10. My sister's middle name is_________.

Kamikawa Tanaka Uehara Nagakura

11. I started smoking...

In 6th grade in 7th grade in 8th grade in 9th grade

12. My favorite color is

gold grey black white

13. I was born in

AZ CO MO Japan

14. What kind of job have I not done?

telemarketing Doctor's office Amusment park Math tutor

15. What did I minor in?

Biology Nursing Asian studies Marketing

Your name

E-mail address

HTML Code

<form method="post" action="https://www.flufo.com/jessica sample/1510/how-well-do-you-know-me">
  <div style="width: 100%;">    
  <h1 style="color: #376e93;">How well do you know me </h1>
         
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>When is my birthday</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12130]" value="A" /> Dec 6</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12130]" value="B" /> Dec 8</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12130]" value="C" /> Dec 28</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12130]" value="D" /> Dec 25</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>What&#039;s my favorite cocktail?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12131]" value="A" /> goose soda</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12131]" value="B" /> stoli soda</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12131]" value="C" /> kettle soda</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12131]" value="D" /> absolute soda</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>What floor is my apartment on?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12132]" value="A" /> 5th</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12132]" value="B" /> 9th</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12132]" value="C" /> 6th</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12132]" value="D" /> 4th</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>favorite food</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12133]" value="A" /> chimichangas</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12133]" value="B" /> noodles</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12133]" value="C" /> clams</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12133]" value="D" /> french fries</label>
      <br />        
      <div style="padding: 5px 0;">5.
      <strong>I have ____ rooms in my apartment</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12134]" value="A" /> 5</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12134]" value="B" /> 4</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12134]" value="C" /> 3</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12134]" value="D" /> 6</label>
      <br />        
      <div style="padding: 5px 0;">6.
      <strong>My grandpa&#039;s name</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12135]" value="A" /> Bill</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12135]" value="B" /> Jim</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12135]" value="C" /> Tex</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12135]" value="D" /> Andy</label>
      <br />        
      <div style="padding: 5px 0;">7.
      <strong>Last concert I went to?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12136]" value="A" /> The killers</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12136]" value="B" /> My chemical romance</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12136]" value="C" /> Bad Religion</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12136]" value="D" /> STP</label>
      <br />        
      <div style="padding: 5px 0;">8.
      <strong>I used to go to work drunk every_______..</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12137]" value="A" /> Tuesday</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12137]" value="B" /> day dammit!</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12137]" value="C" /> Sunday</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12137]" value="D" /> Thursday</label>
      <br />        
      <div style="padding: 5px 0;">9.
      <strong>I still haven&#039;t</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12138]" value="A" /> sky dived</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12138]" value="B" /> bought a lottery ticket</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12138]" value="C" /> been to Europe</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12138]" value="D" /> made a friend in Japan</label>
      <br />        
      <div style="padding: 5px 0;">10.
      <strong>My sister&#039;s middle name is_________.</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12139]" value="A" /> Kamikawa</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12139]" value="B" /> Tanaka</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12139]" value="C" /> Uehara</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12139]" value="D" /> Nagakura</label>
      <br />        
      <div style="padding: 5px 0;">11.
      <strong>I started smoking...</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12140]" value="A" /> In 6th grade</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12140]" value="B" /> in 7th grade</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12140]" value="C" /> in 8th grade</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12140]" value="D" /> in 9th grade</label>
      <br />        
      <div style="padding: 5px 0;">12.
      <strong>My favorite color is</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12141]" value="A" /> gold</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12141]" value="B" /> grey</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12141]" value="C" /> black</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12141]" value="D" /> white</label>
      <br />        
      <div style="padding: 5px 0;">13.
      <strong>I was born in</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12142]" value="A" /> AZ</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12142]" value="B" /> CO</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12142]" value="C" /> MO</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12142]" value="D" /> Japan</label>
      <br />        
      <div style="padding: 5px 0;">14.
      <strong>What kind of job have I not done?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12143]" value="A" /> telemarketing</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12143]" value="B" /> Doctor&#039;s office</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12143]" value="C" /> Amusment park</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12143]" value="D" /> Math tutor</label>
      <br />        
      <div style="padding: 5px 0;">15.
      <strong>What did I minor in?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12144]" value="A" /> Biology</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12144]" value="B" /> Nursing</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12144]" value="C" /> Asian studies</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[12144]" value="D" /> Marketing</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>
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