HTML Code

<form method="post" action="https://www.flufo.com/alma/1681/tell-me">
  <div style="width: 100%;">    
  <h1 style="color: #376e93;">tell me ! </h1>
      <img src="https://www.flufo.com/i/q/747080608.jpg" alt="" border="0" align="right" />   
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>MY NAME IS</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13296]" value="A" /> alma</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13296]" value="B" /> edita</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13296]" value="C" /> safina</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13296]" value="D" /> venesa</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>how old am i ?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13297]" value="A" /> 12</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13297]" value="B" /> 8</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13297]" value="C" /> 13</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13297]" value="D" /> 15</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>my faVOURITE COLOR IS...</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13298]" value="A" /> blue</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13298]" value="B" /> green</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13298]" value="C" /> red</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13298]" value="D" /> black and white</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>i like to live...</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13299]" value="A" /> paris</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13299]" value="B" /> london and paris</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13299]" value="C" /> america</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13299]" value="D" /> kosovo</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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