Jesse's Page...My Survey

Jesse's Page...My Survey


Please Fill In My Form

Your Name and E-mail:

Your URL:

Do You Have A Dog?: Yes No

What's Your Favorite Movie and TV Show?:

Do You Like The Spice Girls?: Yes No Sometimes

How Many Times Have You Seen "Titanic"?: Never Once Twice Three or more

How Old Are You?: 7 or younger 8 to 13 14 to 21 22 to 36
37 to 45 46 to 63 64 to 74 75 or older

Now for the surprise:
If you can answer the following correcly, then you will get a surprise, (don't worry, nothing bad) in your e-mail. (Which means you gotta seriously give me your e-mail address).
Ok, number one: Fill in the blanks:
Every time I to see your face I just close my eyes, and it will take me to a place where your mind and feeling taking shelter in the of my sweet like a .

number two: Who sings that song?

number three: What is the title?

One last thing - here is the ultimate question: If you get this right - (which you wont) - you will be one happy person!

Ok. End off these three sentances:
1) And we're starving and frozen,

2) She said, "Darling, be a dear, haven't slept in a year, I need your help to make my

3) Maybe it's not the moon at all, I hear

Last but not least:
Tell me where 1,2 and 3 come from:

To submit your form, press this button:

To clear the form and start over again, press that button:

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