Do you truly know ME?

1. Why is my middle name Rilee?

no reason they liked it born on grandfather's birthday to be different

2. When did I get my first pair of glasses?

elementary school? middle school? high school? needed from birth?

3. When did i play my first video game system?

23 y.o.? 16 - 19 y.o.? 12 - 15 y.o.? older than 24 years?

4. What was my very first pet?

dog cat fish none

5. What color are my eyes?

brown hazel grey blue

6. What ISN'T one of my medical troubles?

Diabetes Acid Reflux Arthritis Multiple Personality Disorder

7. What name do I call my children?

pests trolls angels trouble

8. What mode of transportation have I never been on?

plane bus boat train

9. Which child of mine wasn't born in Massachusetts?

Gavyn Jordan Ericalyn Skyelar

10. Who was my favorite sister on the TV show Charmed?

Paige Phoebe Piper Pru

Your name

E-mail address

HTML Code

<form method="post" action="https://www.flufo.com/bipolarmom/529/do-you-truly-know-me">
  <div style="width: 100%;">    
  <h1 style="color: #376e93;">Do you truly know ME? </h1>
      <img src="https://www.flufo.com/i/q/1172356009.jpg" alt="" border="0" align="right" />   
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>Why is my middle name Rilee?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3934]" value="A" /> no reason</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3934]" value="B" /> they liked it</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3934]" value="C" /> born on grandfather&#039;s birthday</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3934]" value="D" /> to be different</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>When did I get my first pair of glasses?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3935]" value="A" /> elementary school?</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3935]" value="B" /> middle school?</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3935]" value="C" /> high school?</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3935]" value="D" /> needed from birth?</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>When did i play my first video game system?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3936]" value="A" /> 23 y.o.?</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3936]" value="B" /> 16 - 19 y.o.?</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3936]" value="C" /> 12 - 15 y.o.?</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3936]" value="D" /> older than 24 years?</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>What was my very first pet?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3937]" value="A" /> dog</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3937]" value="B" /> cat</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3937]" value="C" /> fish</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3937]" value="D" /> none</label>
      <br />        
      <div style="padding: 5px 0;">5.
      <strong>What color are my eyes?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3938]" value="A" /> brown</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3938]" value="B" /> hazel</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3938]" value="C" /> grey</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3938]" value="D" /> blue</label>
      <br />        
      <div style="padding: 5px 0;">6.
      <strong>What ISN&#039;T one of my medical troubles?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3939]" value="A" /> Diabetes</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3939]" value="B" /> Acid Reflux</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3939]" value="C" /> Arthritis</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3939]" value="D" /> Multiple Personality Disorder</label>
      <br />        
      <div style="padding: 5px 0;">7.
      <strong>What name do I call my children?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3940]" value="A" /> pests</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3940]" value="B" /> trolls</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3940]" value="C" /> angels</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3940]" value="D" /> trouble</label>
      <br />        
      <div style="padding: 5px 0;">8.
      <strong>What mode of transportation have I never been on?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3941]" value="A" /> plane</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3941]" value="B" /> bus</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3941]" value="C" /> boat</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3941]" value="D" /> train</label>
      <br />        
      <div style="padding: 5px 0;">9.
      <strong>Which child of mine wasn&#039;t born in Massachusetts?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3942]" value="A" /> Gavyn</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3942]" value="B" /> Jordan</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3942]" value="C" /> Ericalyn</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3942]" value="D" /> Skyelar</label>
      <br />        
      <div style="padding: 5px 0;">10.
      <strong>Who was my favorite sister on the TV show Charmed?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3943]" value="A" /> Paige</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3943]" value="B" /> Phoebe</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3943]" value="C" /> Piper</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[3943]" value="D" /> Pru</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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