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  <div style="width: 100%;">    
  <h1 style="color: #376e93;">HOW WELL DO U KNO MEH </h1>
      <img src="https://www.flufo.com/i/q/904571755.jpg" alt="" border="0" align="right" />   
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>WHO DO I HAVE A CRUSH ON</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16267]" value="A" /> J.D</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16267]" value="B" /> D.F</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16267]" value="C" /> PATRICK</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16267]" value="D" /> YOU</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>AM I A VERSION</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16268]" value="A" /> YES</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16268]" value="B" /> NO</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>DID I EVER FRENCH KISS A BOY</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16269]" value="A" /> YES</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16269]" value="B" /> MAYBE</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16269]" value="C" /> NO</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>AM I STILL IN LOVE WITH MY EX BOYFRIEND</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16270]" value="A" /> YES</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16270]" value="B" /> MAYBE</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16270]" value="C" /> HELL NO</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 />
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