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<form method="post" action="https://www.flufo.com/Brooke/2126/how-well-do-you-know-me">
  <div style="width: 100%;">    
  <h1 style="color: #376e93;">How Well Do You Know Me? </h1>
      <img src="https://www.flufo.com/i/q/975454492.jpg" alt="" border="0" align="right" />   
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>Fav color?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16719]" value="A" /> red</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16719]" value="B" /> gray</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16719]" value="C" /> orange</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16719]" value="D" /> Rainbow</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[16720]" value="A" /> 20</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16720]" value="B" /> 18</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16720]" value="C" /> 70</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16720]" value="D" /> 19</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>Where Am I From?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16721]" value="A" /> Ohio</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16721]" value="B" /> New York</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16721]" value="C" /> California</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16721]" value="D" /> Iowa</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>When I my Birthday?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16722]" value="A" /> June 23rd</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16722]" value="B" /> Sept 20</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16722]" value="C" /> June 8th</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[16722]" value="D" /> December 19</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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