Simple Survey

Please tell me your name: (Do not hit return - this will send the form.)

Please enter your e-mail address:

1) How old are you?

Under 18 years old

Between 18 and 24 years old

Between 25 and 34 years old

Between 35 and 44 years old

More than 44 years old

2) How often do you visit my page?

Every Day

Every Week

Once per month

Once per year

3) What are your favorite ice cream flavors?

You may select more than one.

Chocolate

Strawberry

Vanilla

Banana