<HTML>
<FORM ACTION = 'mailto:fraley@uic.edu' METHOD = 'post' ENCTYPE =
'text/plain'>
<INPUT TYPE = 'hidden' NAME = 'v0' VALUE = 'ExampleSurvey'>Welcome to our
survey! <BR><BR>
1. Which of the following foods do you enjoy?
(Check all that apply) <BR>
<INPUT TYPE = 'checkbox' NAME = 'v1' value = '1'> Spinach <BR>
<INPUT TYPE = 'checkbox' NAME = 'v2' value = '1'> Eggplant <BR>
<INPUT TYPE = 'checkbox' NAME = 'v3' value = '1'> Rice <BR>
<INPUT TYPE = 'checkbox' NAME = 'v4' value = '1'> Anything deep fried
<BR><BR><BR>
2. My country of origin is: <BR><SELECT NAME = 'v5' SIZE = '1'>
<OPTION VALUE = '0' SELECTED>--- Please select an
option---</OPTION>
<OPTION VALUE = '1'>USA</OPTION>
<OPTION VALUE = '2'>CANADA</OPTION>
<OPTION VALUE = '3'>MEXICO</OPTION>
<OPTION VALUE = '4'>OTHER</OPTION>
</SELECT><BR><BR>
3. I believe that corporations have too much power.
<BR>Strongly Disagree
<INPUT TYPE = 'radio' NAME = 'v6' value='1'>
<INPUT TYPE = 'radio' NAME = 'v6' value='2'>
<INPUT TYPE = 'radio' NAME = 'v6' value='3'>
<INPUT TYPE = 'radio' NAME = 'v6' value='4'>
<INPUT TYPE = 'radio' NAME = 'v6' value='5'>
<INPUT TYPE = 'radio' NAME = 'v6' value='6'>
<INPUT TYPE = 'radio' NAME = 'v6' value='7'>
Strongly Agree<BR><BR>
4. Please tell me what you think of this book so far.<BR>
<TEXTAREA NAME = 'v7' COLS = '20' ROWS = '6' WRAP = 'virtual'>Please type
here.</TEXTAREA><BR>
<INPUT TYPE = 'submit' VALUE = 'Please click here when finished'>
<BR><BR>Thank you for your participation!
</FORM></HTML>