How well do you know me?

1. Where was I born?

Vancouver WA Seattle WA Longview WA Portland OR

2. When I was growing up my favorite toy's name was...

Oliver Muttley George Tolliver

3. What is my favorite holiday?

Christmas Halloween Forth of July New Years

4. What is my son's full name?

Josiah Micheal Lockwood Josiah Scott Lockwood Josiah Micheal Scott Lockwood Josiah James Lockwood

5. How many Brothers and Sisters do I have?

3 5 7 9

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/1146665277.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[1499]" value="A" /> Vancouver WA</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1499]" value="B" /> Seattle WA</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1499]" value="C" /> Longview WA</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1499]" value="D" /> Portland OR</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>When I was growing up my favorite toy&#039;s name was...</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1500]" value="A" /> Oliver</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1500]" value="B" /> Muttley</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1500]" value="C" /> George</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1500]" value="D" /> Tolliver</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>What is my favorite holiday?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1501]" value="A" /> Christmas</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1501]" value="B" /> Halloween</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1501]" value="C" /> Forth of July</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1501]" value="D" /> New Years</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>What is my son&#039;s full name?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1502]" value="A" /> Josiah Micheal Lockwood</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1502]" value="B" /> Josiah Scott Lockwood</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1502]" value="C" /> Josiah Micheal Scott Lockwood</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1502]" value="D" /> Josiah James Lockwood</label>
      <br />        
      <div style="padding: 5px 0;">5.
      <strong>How many Brothers and Sisters do I have?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1503]" value="A" /> 3</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1503]" value="B" /> 5</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1503]" value="C" /> 7</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[1503]" value="D" /> 9</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;" />     
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    	<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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</form>

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