HTML Code

<form method="post" action="https://www.flufo.com/elizabeth havens/523/how-well-do-you-know-me">
  <div style="width: 100%;">    
  <h1 style="color: #376e93;">How well do you know me? </h1>
         
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>How old am I?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3909]" value="A" /> 15</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3909]" value="B" /> 12</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3909]" value="C" /> 13</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3909]" value="D" /> 16</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>What color is my hair?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3910]" value="A" /> brown</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3910]" value="B" /> blound</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3910]" value="C" /> black</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3910]" value="D" /> red</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>How tall am I?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3911]" value="A" /> 5&#039;11</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3911]" value="B" /> 4&#039;10</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3911]" value="C" /> 6&#039;1</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3911]" value="D" /> 7&#039;1</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>What is my middle name?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3912]" value="A" /> Marrie</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3912]" value="B" /> jane</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3912]" value="C" /> kay</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3912]" value="D" /> lee</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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