How well do you REALLY know me?

1. What is my middle name?

Rachel Raquel Rose None of the above

2. How many children do I have?

One Two Three Four

3. What is my ALL time favorite show?

Desperate Housewives Flavor of Love I love NY Survivor

4. How long have Peo and I been together?

4 years 7 years 8 years 9 years

5. In what city do I work?

Portland Salem Woodburn Tualatin

6. What are the last 4 digits of my cell?

7549 7589 7570 7580

7. What color are my eyes?

Brown Blue Green Violet

8. What is my mom's name?

Francis Maria Linda Valerie

9. What elementry school did I go to?

Lincoln Washington Nellie Muir None of the above

10. Do we have any pets?

One dog One cat one dog and one cat None

Your name

E-mail address

HTML Code

<form method="post" action="https://www.flufo.com/Veronica/876/how-well-do-you-really-know-me">
  <div style="width: 100%;">    
  <h1 style="color: #376e93;">How well do you REALLY know me? </h1>
         
    <br />        
      <div style="padding: 5px 0;">1.
      <strong>What is my middle name?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6992]" value="A" /> Rachel</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6992]" value="B" /> Raquel</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6992]" value="C" /> Rose</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6992]" value="D" /> None of the above</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>How many children do I have?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6993]" value="A" /> One</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6993]" value="B" /> Two</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6993]" value="C" /> Three</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6993]" value="D" /> Four</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>What is my ALL time favorite show?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6994]" value="A" /> Desperate Housewives</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6994]" value="B" /> Flavor of Love</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6994]" value="C" /> I love NY</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6994]" value="D" /> Survivor</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>How long have Peo and I been together?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6995]" value="A" /> 4 years</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6995]" value="B" /> 7 years</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6995]" value="C" /> 8 years</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6995]" value="D" /> 9 years</label>
      <br />        
      <div style="padding: 5px 0;">5.
      <strong>In what city do I work?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6996]" value="A" /> Portland</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6996]" value="B" /> Salem</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6996]" value="C" /> Woodburn</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6996]" value="D" /> Tualatin</label>
      <br />        
      <div style="padding: 5px 0;">6.
      <strong>What are the last 4 digits of my cell?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6997]" value="A" /> 7549</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6997]" value="B" /> 7589</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6997]" value="C" /> 7570</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6997]" value="D" /> 7580</label>
      <br />        
      <div style="padding: 5px 0;">7.
      <strong>What color are my eyes?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6998]" value="A" /> Brown</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6998]" value="B" /> Blue</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6998]" value="C" /> Green</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6998]" value="D" /> Violet</label>
      <br />        
      <div style="padding: 5px 0;">8.
      <strong>What is my mom&#039;s name?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6999]" value="A" /> Francis</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6999]" value="B" /> Maria</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6999]" value="C" /> Linda</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[6999]" value="D" /> Valerie</label>
      <br />        
      <div style="padding: 5px 0;">9.
      <strong>What elementry school did I go to?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7000]" value="A" /> Lincoln</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7000]" value="B" /> Washington</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7000]" value="C" /> Nellie Muir</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7000]" value="D" /> None of the above</label>
      <br />        
      <div style="padding: 5px 0;">10.
      <strong>Do we have any pets?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7001]" value="A" /> One dog</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7001]" value="B" /> One cat</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7001]" value="C" /> one dog and one cat</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7001]" value="D" /> None</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>
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