<?php
include "../funcs/file_func.php";
$referer = $_SERVER['HTTP_REFERER'];
if($referer && substr($referer, 0, 7) == 'http://')
    append_file("../../referer_files/life_ref.txt", date("m/d/y  H:i:s") . ' -  ' . $referer . "\n");
?>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<title>Rate My Life Self-Help Quiz - How Good Is Your Life?</title>
<link rel="stylesheet" type="text/css" href="life.css">
</head>
<body>

<h1>Go Ahead, Rate My Life...</h1>

<div style="float: left; width: 120px; margin: 0px; padding: 0px;">
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<p style="width: 500px; margin-left: 124px;">
<!-- google_ad_section_start -->
The Rate My Life Self-Help Quiz will ask you a number of questions and then compute your <a href="life.html">life</a> rating.  
In addition, it will break down your score on the following categories: <a href="advice-mind.html">Mind</a>, 
<a href="advice-body.html">Body</a>, <a href="advice-spirit.html">Spirit</a>, 
<a href="advice-love.html">Love</a>, Friends/Family, and <a href="advice-finance.html">Financial</a>.  Finally, it will analyze your scores. 
Please note that this quiz is intended for entertainment purposes only.
<!-- google_ad_section_end --><br>

<b>Will your bars be shades of orange, or blue? Take the quiz and find out.</b></p>

<p style="width: 500px; margin-left: 124px;">
Please answer all the questions. You may skip some of the questions 
if you want, but the quiz will function better if all questions are answered. 
The first two are mandatory. 
<!-- google_ad_section_start(weight=ignore) -->
Pri&#118;acy Statement: The answers you fill out are not saved on 
our server, other than in aggregate form for a select few questions (eg. <i>"23% of quiz-takers are married"</i>).  
We do not retain any user-specific da&#116;a whatsoever from this quiz, nor do we share 
your answers with anyone.  In other words, your pri&#118;acy and anonymity are guaranteed.  See the 
<a href="privacy.html">Privacy Policy</a> for more information.  You can view some statistical 
analysis on the <a href="life_stats.html">life score results</a> from this quiz.
<!-- google_ad_section_end -->
</p>

<div class="spec">
  <a href="http://www.tkqlhce.com/4c106xdmjdl02855A690214782A6" target="_top" onmouseover="window.status='http://www.americansingles.com/default.asp?p=7090&prm=44816';return true;" onmouseout="window.status=' ';return true;">
  <img src="http://www.awltovhc.com/fo122r6Az42OQWTTYUXOQPSVWQYU" alt="Free Registration - AmericanSingles.com " border="0"></a>
</div>

<form action="rate_my_life2.html" method="post">

<p>*What is your age? 
<select name="age">
  <option value="x">-Please Select-</option>
  <option value="17">Under 18</option>
  <option value="18">18 - 22</option>
  <option value="23">23 - 29</option>
  <option value="30">30 - 39</option>
  <option value="40">40 - 49</option>
  <option value="50">50 or Above</option>
</select></p>

<p>*What is your gender? 
<select name="gender">
  <option value="x">-Please Select-</option>
  <option value="m">Male</option>
  <option value="f">Female</option>
</select></p>

<div style="width: 637px; padding: 0px; margin: 0px;">
<div style="float: right; width: 80px; padding: 0px; margin: 0px;  margin-top: 5px;">
<a href="http://www.tkqlhce.com/5k117wktqks79FCCHDG798BG9HBB" target="_blank" onmouseover="window.status='http://www.yourstar.com';return true;" onmouseout="window.status=' ';return true;">
<img src="http://www.awltovhc.com/kl70uuymsqBDJGGLHKBDCFKDLFF" alt="" border="0"></a>
</div>
<p class="sm">What is your sexual orientation? 
<select name="orientation">
  <option value="x">-Please Select-</option>
  <option value="s">Straight</option>
  <option value="b">Bisexual</option>
  <option value="g">Gay</option>
  <option value="u">Undecided</option>
</select></p>

<p class="sm">How many of your grandparents are still alive? 
<select name="gparents">
  <option value="x">-Please Select-</option>
  <option value="0">Zero</option>
  <option value="1">One</option>
  <option value="2">Two</option>
  <option value="3">Three</option>
  <option value="4">Four</option>
</select></p>

<p class="sm">How many children do you have? 
<select name="children">
  <option value="x">-Please Select-</option>
  <option value="0">Zero</option>
  <option value="1">One</option>
  <option value="2">Two</option>
  <option value="3">Three</option>
  <option value="4">Four</option>
  <option value="5">Five or More</option>
</select></p>

<p class="sm">What is your marital status? 
<select name="marital">
  <option value="x">-Please Select-</option>
  <option value="n">Never Married</option>
  <option value="m">Married</option>
  <option value="d">Divorced</option>
  <option value="r">Re-Married (2nd, 3rd, etc)</option>
</select></p>

<p class="sm">How many brothers and sisters do you have? 
<select name="siblings">
  <option value="x">-Please Select-</option>
  <option value="0">Zero</option>
  <option value="1">One</option>
  <option value="2">Two</option>
  <option value="3">Three</option>
  <option value="4">Four</option>
  <option value="5">Five or More</option>
</select></p>

<p class="sm">How many good friends do you have? 
<select name="friends">
  <option value="x">-Please Select-</option>
  <option value="0">Zero</option>
  <option value="1">One or Two</option>
  <option value="3">Three to Five</option>
  <option value="6">Six to Ten</option>
  <option value="10">More than Ten</option>
</select></p>

<p class="sm">What is your religion? 
<select name="religion">
  <option value="x">-Please Select-</option>
  <option value="ag">Agnostic or Undecided</option>
  <option value="at">Atheist</option>
  <option value="b">Buddhism</option>
  <option value="c">Christianity</option>
  <option value="d">Deism</option>
  <option value="h">Hinduism</option>
  <option value="i">Islam</option>
  <option value="j">Judaism</option>
  <option value="n">New Age</option>
  <option value="o">Other</option>
  <option value="sc">Scientology</option>
  <option value="si">Sikhism</option>
  <option value="w">Wicca</option>
</select></p>

<p class="sm">What body-weight are you? 
<select name="fitness">
  <option value="x">-Please Select-</option>
  <option value="u">Underweight</option>
  <option value="h">Healthy Weight</option>
  <option value="so">Slightly Overweight</option>
  <option value="vo">Very Overweight</option>
</select></p>

<p class="sm">How recently has someone very important to you died? 
<select name="died">
  <option value="x">-Please Select-</option>
  <option value="0">Zero to Six Months</option>
  <option value="6m">Six Months to a Year</option>
  <option value="1">One to Two Years</option>
  <option value="3">Three to Six Years</option>
  <option value="6y">More than Six Years</option>
</select></p>

<p class="sm">Other than death of a loved one, have you had a traumatic experience recently?<br>
<input type="radio" name="trauma" value="y"> Yes<br>
<input type="radio" name="trauma" value="n"> No</p>

<p class="sm">Have you ever been in prison?<br>
<input type="radio" name="prison" value="y"> Yes<br>
<input type="radio" name="prison" value="n"> No</p>

<p class="sm">Do you travel?<br>
<input type="radio" name="travel" value="y"> Yes<br>
<input type="radio" name="travel" value="n"> No</p>

<p class="sm">Do you have any major illnesses?<br>
<input type="radio" name="ill" value="y"> Yes<br>
<input type="radio" name="ill" value="n"> No</p>

<p class="sm">Do you have any non-major, chronic illnesses?<br>
<input type="radio" name="chronic" value="y"> Yes<br>
<input type="radio" name="chronic" value="n"> No</p>

<p class="sm">Do you have any non-illness disabilities?<br>
<input type="radio" name="disabled" value="y"> Yes<br>
<input type="radio" name="disabled" value="n"> No</p>
</div>

<p>Are you employed?<br>
<input type="radio" name="employed" value="y"> Yes<br>
<input type="radio" name="employed" value="n"> No</p>

<p>Are you enlisted in the armed services?<br>
<input type="radio" name="enlisted" value="y"> Yes<br>
<input type="radio" name="enlisted" value="n"> No</p>

<p>Is there pollution in the air, water, or soil where you live?<br>
<input type="radio" name="pollution" value="y"> Yes<br>
<input type="radio" name="pollution" value="n"> No</p>

<p>Do you eat fruits and vegetables every day?<br>
<input type="radio" name="fruits" value="y"> Yes<br>
<input type="radio" name="fruits" value="n"> No</p>

<p>Are you financially-independent?<br>
<input type="radio" name="finance" value="y"> Yes<br>
<input type="radio" name="finance" value="n"> No</p>

<p>Do others regard you as a person of good character?<br>
<input type="radio" name="character" value="y"> Yes<br>
<input type="radio" name="character" value="n"> No</p>

<p>Are there one or more people who currently find you romantically desirable?<br>
<input type="radio" name="desire" value="y"> Yes<br>
<input type="radio" name="desire" value="n"> No</p>

<p>Check off any pets that you have:<br>
<input type="checkbox" name="pet[]" value="d"> Dog<br>
<input type="checkbox" name="pet[]" value="c"> Cat<br>
<input type="checkbox" name="pet[]" value="b"> Bird<br>
<input type="checkbox" name="pet[]" value="f"> Fish<br>
<input type="checkbox" name="pet[]" value="s"> Small mammal<br>
<input type="checkbox" name="pet[]" value="r"> Reptile/Amphibian<br>
<input type="checkbox" name="pet[]" value="o"> Other</p>

<p>Are you gifted in any of these areas?<br>
<input type="checkbox" name="gifted[]" value="mu"> Musical Instrument<br>
<input type="checkbox" name="gifted[]" value="si"> Singing<br>
<input type="checkbox" name="gifted[]" value="a"> Art<br>
<input type="checkbox" name="gifted[]" value="ma"> Math<br>
<input type="checkbox" name="gifted[]" value="com"> Computers<br>
<input type="checkbox" name="gifted[]" value="so"> Sports<br>
<input type="checkbox" name="gifted[]" value="coo"> Cooking</p>

<p>Check off any of the following that you are addicted to:<br>
<input type="checkbox" name="addict[]" value="co"> Coffee<br>
<input type="checkbox" name="addict[]" value="a"> Alcohol<br>
<input type="checkbox" name="addict[]" value="m"> Medicinal Drugs<br>
<input type="checkbox" name="addict[]" value="i"> Illicit Drugs<br>
<input type="checkbox" name="addict[]" value="j"> Junk Food<br>
<input type="checkbox" name="addict[]" value="ci"> Cigarettes</p>

<p>Are any of your senses impaired (beyond correction with glasses, hearing aid, etc.)?<br>
<input type="checkbox" name="sense[]" value="si"> Sight<br>
<input type="checkbox" name="sense[]" value="h"> Hearing<br>
<input type="checkbox" name="sense[]" value="ta"> Taste<br>
<input type="checkbox" name="sense[]" value="sm"> Smell<br>
<input type="checkbox" name="sense[]" value="to"> Touch</p>

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    echo '<input type="hidden" name="ms" value="t">';
?>

<input type="submit" value=" Continue ">

</form>
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