<form action='http://www.kwiz.biz/simplesurveys/do-survey.php' method='post' target='_new'><table border=1 bordercolor=#efefef cellspacing=0><tr><td valign=top align=center colspan=2><b><i>TELL ME ABOUT YOURSELF – The Survey</i></b><input type='hidden' name='question1' value='TELL+ME+ABOUT+YOURSELF+-+The+Survey'><input type='hidden' name='type1' value='2'></td></tr><tr><td valign=top align=right>Name:</td><td align=left><b>Jamaica Taylor</b><input type='hidden' name='question2' value='Name%3A'><input type='hidden' name='type2' value='1'></td></tr><tr><td valign=top align=right>Birthday:</td><td align=left><b>July 16</b><input type='hidden' name='question3' value='Birthday%3A'><input type='hidden' name='type3' value='1'></td></tr><tr><td valign=top align=right>Birthplace:</td><td align=left><b>Portlan, Oregon</b><input type='hidden' name='question4' value='Birthplace%3A'><input type='hidden' name='type4' value='1'></td></tr><tr><td valign=top align=right>Current Location:</td><td align=left><b>Richmond, VA</b><input type='hidden' name='question5' value='Current+Location%3A'><input type='hidden' name='type5' value='1'></td></tr><tr><td valign=top align=right>Eye Color:</td><td align=left><b>brown</b><input type='hidden' name='question6' value='Eye+Color%3A'><input type='hidden' name='type6' value='1'></td></tr><tr><td valign=top align=right>Hair Color:</td><td align=left><b>black</b><input type='hidden' name='question7' value='Hair+Color%3A'><input type='hidden' name='type7' value='1'></td></tr><tr><td valign=top align=right>Height:</td><td align=left><b>5'8</b><input type='hidden' name='question8' value='Height%3A'><input type='hidden' name='type8' value='1'></td></tr><tr><td valign=top align=right>Right Handed or Left Handed:</td><td align=left><b>Left handed</b><input type='hidden' name='question9' value='Right+Handed+or+Left+Handed%3A'><input type='hidden' name='type9' value='1'></td></tr><tr><td valign=top align=right>The Shoes You Wore Today:</td><td align=left><b>boots</b><input type='hidden' name='question11' value='The+Shoes+You+Wore+Today%3A'><input type='hidden' name='type11' value='1'></td></tr><tr><td valign=top align=right>Your Weakness:</td><td align=left><b>none i can think of at the moment</b><input type='hidden' name='question12' value='Your+Weakness%3A'><input type='hidden' name='type12' value='1'></td></tr><tr><td valign=top align=right>Your Fears:</td><td align=left><b>spiders, of my past happening again</b><input type='hidden' name='question13' value='Your+Fears%3A'><input type='hidden' name='type13' value='1'></td></tr><tr><td valign=top align=right>Your Perfect Pizza:</td><td align=left><b>pepperoni and mushrooms</b><input type='hidden' name='question14' value='Your+Perfect+Pizza%3A'><input type='hidden' name='type14' value='1'></td></tr><tr><td valign=top align=right>Goal You Would Like To Achieve This Year:</td><td align=left><b>to get a job</b><input type='hidden' name='question15' value='Goal+You+Would+Like+To+Achieve+This+Year%3A'><input type='hidden' name='type15' value='1'></td></tr><tr><td valign=top align=right>Your Most Overused Phrase On an instant messenger:</td><td align=left><b>lol</b><input type='hidden' name='question16' value='Your+Most+Overused+Phrase+On+an+instant+messenger%3A'><input type='hidden' name='type16' value='1'></td></tr><tr><td valign=top align=right>Thoughts First Waking Up:</td><td align=left><b>im tired</b><input type='hidden' name='question17' value='Thoughts+First+Waking+Up%3A'><input type='hidden' name='type17' value='1'></td></tr><tr><td valign=top align=right>Your Best Physical Feature:</td><td align=left><b>my body</b><input type='hidden' name='question18' value='Your+Best+Physical+Feature%3A'><input type='hidden' name='type18' value='1'></td></tr><tr><td valign=top align=right>Your Bedtime:</td><td align=left><b>9 pm</b><input type='hidden' name='question19' value='Your+Bedtime%3A'><input type='hidden' name='type19' value='1'></td></tr><tr><td valign=top align=right>Your Most Missed Memory:</td><td align=left><b>chillling with my best friend</b><input type='hidden' name='question20' value='Your+Most+Missed+Memory%3A'><input type='hidden' name='type20' value='1'></td></tr><tr><td valign=top align=right>Pepsi or Coke:</td><td align=left><b>Pepsi</b><input type='hidden' name='question21' value='Pepsi+or+Coke%3A'><input type='hidden' name='type21' value='1'></td></tr><tr><td valign=top align=right>MacDonalds or Burger King:</td><td align=left><b>Burger King</b><input type='hidden' name='question22' value='MacDonalds+or+Burger+King%3A'><input type='hidden' name='type22' value='1'></td></tr><tr><td valign=top align=right>Single or Group Dates:</td><td align=left><b>Single</b><input type='hidden' name='question23' value='Single+or+Group+Dates%3A'><input type='hidden' name='type23' value='1'></td></tr><tr><td valign=top align=right>Lipton Ice Tea or Nestea:</td><td align=left><b>Nesta</b><input type='hidden' name='question24' value='Lipton+Ice+Tea+or+Nestea%3A'><input type='hidden' name='type24' value='1'></td></tr><tr><td valign=top align=right>Chocolate or Vanilla:</td><td align=left><b>Chocolate</b><input type='hidden' name='question25' value='Chocolate+or+Vanilla%3A'><input type='hidden' name='type25' value='1'></td></tr><tr><td valign=top align=right>Cappuccino or Coffee:</td><td align=left><b>Coffee</b><input type='hidden' name='question26' value='Cappuccino+or+Coffee%3A'><input type='hidden' name='type26' value='1'></td></tr><tr><td valign=top align=right>Do you Smoke:</td><td align=left><b>sometimes</b><input type='hidden' name='question27' value='Do+you+Smoke%3A'><input type='hidden' name='type27' value='1'></td></tr><tr><td valign=top align=right>Do you Swear:</td><td align=left><b>yes</b><input type='hidden' name='question28' value='Do+you+Swear%3A'><input type='hidden' name='type28' value='1'></td></tr><tr><td valign=top align=right>Do you Sing:</td><td align=left><b>no</b><input type='hidden' name='question29' value='Do+you+Sing%3A'><input type='hidden' name='type29' value='1'></td></tr><tr><td valign=top align=right>Do you Shower Daily:</td><td align=left><b>yes</b><input type='hidden' name='question30' value='Do+you+Shower+Daily%3A'><input type='hidden' name='type30' value='1'></td></tr><tr><td valign=top align=right>Have you Been in Love:</td><td align=left><b>yes </b><input type='hidden' name='question31' value='Have+you+Been+in+Love%3A'><input type='hidden' name='type31' value='1'></td></tr><tr><td valign=top align=right>Do you want to get Married:</td><td align=left><b>im not sure</b><input type='hidden' name='question33' value='Do+you+want+to+get+Married%3A'><input type='hidden' name='type33' value='1'></td></tr><tr><td valign=top align=right>Do you belive in yourself:</td><td align=left><b>yes</b><input type='hidden' name='question34' value='Do+you+belive+in+yourself%3A'><input type='hidden' name='type34' value='1'></td></tr><tr><td valign=top align=right>Do you get Motion Sickness:</td><td align=left><b>no</b><input type='hidden' name='question35' value='Do+you+get+Motion+Sickness%3A'><input type='hidden' name='type35' value='1'></td></tr><tr><td valign=top align=right>Do you think you are Attractive:</td><td align=left><b>yes</b><input type='hidden' name='question36' value='Do+you+think+you+are+Attractive%3A'><input type='hidden' name='type36' value='1'></td></tr><tr><td valign=top align=right>Are you a Health Freak:</td><td align=left><b>no</b><input type='hidden' name='question37' value='Are+you+a+Health+Freak%3A'><input type='hidden' name='type37' value='1'></td></tr><tr><td valign=top align=right>Do you get along with your Parents:</td><td align=left><b>don't know mines</b><input type='hidden' name='question38' value='Do+you+get+along+with+your+Parents%3A'><input type='hidden' name='type38' value='1'></td></tr><tr><td valign=top align=right>Do you like Thunderstorms:</td><td align=left><b>no</b><input type='hidden' name='question39' value='Do+you+like+Thunderstorms%3A'><input type='hidden' name='type39' value='1'></td></tr><tr><td valign=top align=right>Do you play an Instrument:</td><td align=left><b>used to play clarinet and viola</b><input type='hidden' name='question40' value='Do+you+play+an+Instrument%3A'><input type='hidden' name='type40' value='1'></td></tr><tr><td valign=top align=right>In the past month have you Drank Alcohol:</td><td align=left><b>no</b><input type='hidden' name='question41' value='In+the+past+month+have+you+Drank+Alcohol%3A'><input type='hidden' name='type41' value='1'></td></tr><tr><td valign=top align=right>In the past month have you Smoked:</td><td align=left><b>no</b><input type='hidden' name='question42' value='In+the+past+month+have+you+Smoked%3A'><input type='hidden' name='type42' value='1'></td></tr><tr><td valign=top align=right>In the past month have you gone on a Date:</td><td align=left><b>no</b><input type='hidden' name='question44' value='In+the+past+month+have+you+gone+on+a+Date%3A'><input type='hidden' name='type44' value='1'></td></tr><tr><td valign=top align=right>In the past month have you gone to a Mall:</td><td align=left><b>yes</b><input type='hidden' name='question45' value='In+the+past+month+have+you+gone+to+a+Mall%3A'><input type='hidden' name='type45' value='1'></td></tr><tr><td valign=top align=right>In the past month have you eaten a box of Oreos:</td><td align=left><b>no</b><input type='hidden' name='question46' value='In+the+past+month+have+you+eaten+a+box+of+Oreos%3A'><input type='hidden' name='type46' value='1'></td></tr><tr><td valign=top align=right>In the past month have you eaten Sushi:</td><td align=left><b>no</b><input type='hidden' name='question47' value='In+the+past+month+have+you+eaten+Sushi%3A'><input type='hidden' name='type47' value='1'></td></tr><tr><td valign=top align=right>In the past month have you been on Stage:</td><td align=left><b>no</b><input type='hidden' name='question48' value='In+the+past+month+have+you+been+on+Stage%3A'><input type='hidden' name='type48' value='1'></td></tr><tr><td valign=top align=right>In the past month have you been Dumped:</td><td align=left><b>no</b><input type='hidden' name='question49' value='In+the+past+month+have+you+been+Dumped%3A'><input type='hidden' name='type49' value='1'></td></tr><tr><td valign=top align=right>In the past month have you gone Skinny Dipping:</td><td align=left><b>no</b><input type='hidden' name='question50' value='In+the+past+month+have+you+gone+Skinny+Dipping%3A'><input type='hidden' name='type50' value='1'></td></tr><tr><td valign=top align=right>In the past month have you Stolen Anything:</td><td align=left><b>no</b><input type='hidden' name='question51' value='In+the+past+month+have+you+Stolen+Anything%3A'><input type='hidden' name='type51' value='1'></td></tr><tr><td valign=top align=right>Ever been Drunk:</td><td align=left><b>yes</b><input type='hidden' name='question52' value='Ever+been+Drunk%3A'><input type='hidden' name='type52' value='1'></td></tr><tr><td valign=top align=right>Ever been called a Tease:</td><td align=left><b>yes</b><input type='hidden' name='question53' value='Ever+been+called+a+Tease%3A'><input type='hidden' name='type53' value='1'></td></tr><tr><td valign=top align=right>Ever been Beaten up:</td><td align=left><b>yes</b><input type='hidden' name='question54' value='Ever+been+Beaten+up%3A'><input type='hidden' name='type54' value='1'></td></tr><tr><td valign=top align=right>Ever Shoplifted:</td><td align=left><b>yes</b><input type='hidden' name='question55' value='Ever+Shoplifted%3A'><input type='hidden' name='type55' value='1'></td></tr><tr><td valign=top align=right>How do you want to Die:</td><td align=left><b>painless and in my sleep</b><input type='hidden' name='question56' value='How+do+you+want+to+Die%3A'><input type='hidden' name='type56' value='1'></td></tr><tr><td valign=top align=right>What do you want to be when you Grow Up:</td><td align=left><b>be a proffessional writer, and a therapist/counselor</b><input type='hidden' name='question57' value='What+do+you+want+to+be+when+you+Grow+Up%3A'><input type='hidden' name='type57' value='1'></td></tr><tr><td valign=top align=right>What country would you most like to Visit:</td><td align=left><b>Jamaica again</b><input type='hidden' name='question58' value='What+country+would+you+most+like+to+Visit%3A'><input type='hidden' name='type58' value='1'></td></tr><tr><td valign=top align=center colspan=2><b><i>In a Boy/Girl..</i></b><input type='hidden' name='question59' value='In+a+Boy%2FGirl..'><input type='hidden' name='type59' value='2'></td></tr><tr><td valign=top align=right>Favourite Eye Color:</td><td align=left><b>idc</b><input type='hidden' name='question60' value='Favourite+Eye+Color%3A'><input type='hidden' name='type60' value='1'></td></tr><tr><td valign=top align=right>Favourite Hair Color:</td><td align=left><b>idc</b><input type='hidden' name='question61' value='Favourite+Hair+Color%3A'><input type='hidden' name='type61' value='1'></td></tr><tr><td valign=top align=right>Short or Long Hair:</td><td align=left><b>idc</b><input type='hidden' name='question62' value='Short+or+Long+Hair%3A'><input type='hidden' name='type62' value='1'></td></tr><tr><td valign=top align=right>Height:</td><td align=left><b>taller than me</b><input type='hidden' name='question63' value='Height%3A'><input type='hidden' name='type63' value='1'></td></tr><tr><td valign=top align=right>Weight:</td><td align=left><b>idc</b><input type='hidden' name='question64' value='Weight%3A'><input type='hidden' name='type64' value='1'></td></tr><tr><td valign=top align=right>Best Clothing Style:</td><td align=left><b>idc</b><input type='hidden' name='question65' value='Best+Clothing+Style%3A'><input type='hidden' name='type65' value='1'></td></tr><tr><td valign=top align=right>Number of Drugs I have taken:</td><td align=left><b>1</b><input type='hidden' name='question66' value='Number+of+Drugs+I+have+taken%3A'><input type='hidden' name='type66' value='1'></td></tr><tr><td valign=top align=right>Number of CDs I own:</td><td align=left><b>15</b><input type='hidden' name='question68' value='Number+of+CDs+I+own%3A'><input type='hidden' name='type68' value='1'></td></tr><tr><td valign=top align=right>Number of Piercings:</td><td align=left><b>1 in each ear</b><input type='hidden' name='question69' value='Number+of+Piercings%3A'><input type='hidden' name='type69' value='1'></td></tr><tr><td valign=top align=right>Number of Tattoos:</td><td align=left><b>none</b><input type='hidden' name='question70' value='Number+of+Tattoos%3A'><input type='hidden' name='type70' value='1'></td></tr><tr><td valign=top align=right>Number of things in my Past I Regret:</td><td align=left><b>5</b><input type='hidden' name='question71' value='Number+of+things+in+my+Past+I+Regret%3A'><input type='hidden' name='type71' value='1'></td></tr><tr><td colspan=2 align=center><input type='submit' value='Take This Survey'><BR><a href='http://www.kwiz.biz/simplesurveys/create-survey.php'>CREATE YOUR OWN!</a> – or – <a href='http://www.kwiz.biz/simplesurveys/paid-surveys.php'>GET PAID TO TAKE SURVEYS!</a></td></tr></form></table>
0 Comments

Leave a reply

© 2021 WebTribes Inc. | find your tribe

Log in with your credentials

or    

Forgot your details?

Create Account