How well do you know me?

1. Where was i born?

Mexico Chicago Las Vegas

2. When is my birthday

July 5, 1985 June 5, 1986 July 6, 1986

3. What is my daughters name?

Citlaly Jazlyn Citlaly Jazmine Citlaly

4. What am i majoring in?

Basic addictions and counceling Registed Nurse Juvenile Justice Parole

5. What kind of car do i drive?

'07 Honda Civic '07 Impala '07 Honda Pilot

6. Where is my favorite spot to go?

Lake Mall My room ;)

Your name

E-mail address

HTML Code

<form method="post" action="https://www.flufo.com/Erika/898/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>Where was i born?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7170]" value="A" /> Mexico</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7170]" value="B" /> Chicago</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7170]" value="C" /> Las Vegas</label>
      <br />        
      <div style="padding: 5px 0;">2.
      <strong>When is my birthday</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7171]" value="A" /> July 5, 1985</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7171]" value="B" /> June 5, 1986</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7171]" value="C" /> July 6, 1986</label>
      <br />        
      <div style="padding: 5px 0;">3.
      <strong>What is my daughters name?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7172]" value="A" /> Citlaly Jazlyn</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7172]" value="B" /> Citlaly Jazmine</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7172]" value="C" /> Citlaly</label>
      <br />        
      <div style="padding: 5px 0;">4.
      <strong>What am i majoring in?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7173]" value="A" /> Basic addictions and counceling</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7173]" value="B" /> Registed Nurse</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7173]" value="C" /> Juvenile Justice Parole</label>
      <br />        
      <div style="padding: 5px 0;">5.
      <strong>What kind of car do i drive?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7174]" value="A" /> &#039;07 Honda Civic</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7174]" value="B" /> &#039;07 Impala</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7174]" value="C" /> &#039;07 Honda Pilot</label>
      <br />        
      <div style="padding: 5px 0;">6.
      <strong>Where is my favorite spot to go?</strong>  
    </div>
                <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7175]" value="A" /> Lake</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7175]" value="B" /> Mall</label>
                  <label style="display: block; margin: 3px 0;"><input type="radio" name="correctAnswer[7175]" value="C" /> My room ;)</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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