How well do you know me?

1. Where was I born?

Ontario Oregon Boise Idaho Nampa Idaho Pendleton Oregon

2. What is my favorite colors?

Hot pink and Orange Brown and blue Red and yellow All colors

3. Do I have any children? And how many?

no yes, 1 Yes, 2 Not sure

4. Have I ever been married?

Yes No Not sure Possible

Your name

E-mail address

HTML Code

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  <div style="width: 100%;">    
  <h1 style="color: #376e93;">How well do you know me? </h1>
      <img src="https://www.flufo.com/i/q/478618407.jpg" alt="" border="0" align="right" />   
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>Where was I born?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14380]" value="A" /> Ontario Oregon</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14380]" value="B" /> Boise Idaho</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14380]" value="C" /> Nampa Idaho</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14380]" value="D" /> Pendleton Oregon</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>What is my favorite colors?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14381]" value="A" /> Hot pink and Orange</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14381]" value="B" /> Brown and blue</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14381]" value="C" /> Red and yellow</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14381]" value="D" /> All colors</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>Do I have any children? And how many?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14382]" value="A" /> no</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14382]" value="B" /> yes, 1</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14382]" value="C" /> Yes, 2</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14382]" value="D" /> Not sure</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>Have I ever been married?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14383]" value="A" /> Yes</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14383]" value="B" /> No</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14383]" value="C" /> Not sure</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[14383]" value="D" /> Possible</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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