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Here is a little survey:

1.What is your favorite movie?
Starwars
Titanic
X-men

2. Which of the following color do you like?
Black
Red
White
Green

3. How many hours do you spend on computer pr. week?
less than 5 hr.
less than 10 hr.
less than 15 hr.
more than 20 hr.

4. Please enter your name and your email.
Name
Email