What do you know about me?

1. When is my birthday?

December 28,1995 December 28,1996 January 6, 1995 December 28, 2008

2. What is my favorite book?

The Clique Twilight Wedding Planner Nancy Drew

3. What is my favorite celebrity?

Chris Brown Will Smith Beyonce' Bow Wow

4. What is my favorite thing to do?

Sing Dance Eat Beat up my little brother

Your name

E-mail address

HTML Code

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  <div style="width: 100%;">    
  <h1 style="color: #376e93;">What do you know about 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[13700]" value="A" /> December 28,1995</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13700]" value="B" /> December 28,1996</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13700]" value="C" /> January 6, 1995</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13700]" value="D" /> December 28, 2008</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>What is my favorite book?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13701]" value="A" /> The Clique</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13701]" value="B" /> Twilight</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13701]" value="C" /> Wedding Planner</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13701]" value="D" /> Nancy Drew</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>What is my favorite celebrity?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13702]" value="A" /> Chris Brown</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13702]" value="B" /> Will Smith</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13702]" value="C" /> Beyonce&#039;</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13702]" value="D" /> Bow Wow</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>What is my favorite thing to do?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13703]" value="A" /> Sing</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13703]" value="B" /> Dance</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13703]" value="C" /> Eat</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[13703]" value="D" /> Beat up my little brother</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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