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<div align="center" style="font-family: Tahoma, Verdana, Arial, Helvetica, sans-serif; font-size: 10pt;"><form action="http://quizzes.blogquiz.net/fun-quizzes/LiveJournal-Memes/YOUR-LJ-TRIP-TO-THE-EMERGENCY-ROOM-livejournal-meme-quiz_aWQ9MjY5Mg.html" method="post" name="quiz2692"><table border="1" cellspacing="0" cellpadding="0"><tr><td><table style="font-family: Tahoma, Verdana, Arial, Helvetica, sans-serif; font-size: 10pt;" border="0" cellspacing="0" cellpadding="3"><tr bgcolor="#003366"><td colspan="2" align="center" valign="middle"><div align="center" style="color: #FFFFFF; font-weight: bold;"><a href="http://quizzes.blogquiz.net/fun-quizzes/LiveJournal-Memes/YOUR-LJ-TRIP-TO-THE-EMERGENCY-ROOM-livejournal-meme-quiz_aWQ9MjY5Mg.html" style="color: #FFFFFF; text-decoration: none;">YOUR LJ TRIP TO THE EMERGENCY ROOM</a></div></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">LiveJournal Username</td><td align="left" valign="middle"><input type="textbox" name="ljusername" value="" size="20" maxlength="64"></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">How old were you when you lost your virginity?</td><td align="left" valign="middle"><input type="textbox" name="input:0" value="" size="20" maxlength="64"></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">How old were you really?</td><td align="left" valign="middle"><input type="textbox" name="input:1" value="" size="20" maxlength="64"></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">Do you like to play with fire?</td><td align="left" valign="middle"><select name="input:2"><option value="0" selected>HELL YEAH!</option><option value="1" >Yes</option><option value="2" >sort of</option><option value="3" >no</option><option value="4" >Are you a police officer, or are you affiliated with any law enforcement agency?</option></select></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">Do you practice safe sex?</td><td align="left" valign="middle"><select name="input:3"><option value="0" selected>Condoms yes, but I broke my hip once, doing the nasty...</option><option value="1" >Always</option><option value="2" >No, it feels funny</option><option value="3" >No, I already have HIV, so why would I care?</option><option value="4" >No, I like playing Russian Roulette with my life, and the lives of others.</option></select></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">Do you chew on your pens/pencils?</td><td align="left" valign="middle"><select name="input:4"><option value="0" selected>I swallow thwm whole!</option><option value="1" >Yes I do, so?</option><option value="2" >Only when I'm under a great deal of stress.</option><option value="3" >No</option></select></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">Favorite Breakfast cereal?</td><td align="left" valign="middle"><input type="textbox" name="input:5" value="" size="20" maxlength="64"></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">How many points do you have left on your driver's license?</td><td align="left" valign="middle"><select name="input:6"><option value="0" selected>none</option><option value="1" >2</option><option value="2" >6</option><option value="3" >12</option><option value="4" >all of them</option><option value="5" >What license?</option></select></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">Favorite food?</td><td align="left" valign="middle"><input type="textbox" name="input:7" value="" size="20" maxlength="64"></td></tr><tr bgcolor="#003366" height="5"><td colspan="2"></td></tr><tr bgcolor="#003366"><td colspan="2" align="center" valign="middle"><div align="center"><input type="submit" name="submit" value="Fill in your answers and click here!" style="font-size: 9pt;"></div></td></tr><tr bgcolor="#003366"><td colspan="2" align="center" valign="middle"><div style="color: #FFFFFF;" align="center">This <a href="http://www.blogquiz.net/" style="color: #FFFFFF;">Fun Quiz</a> created by <a href="http://www.blogquiz.net/users/shagadellique" style="color: #FFFFFF;">jennifer</a> at <strong>BlogQuiz.Net</strong><img src="http://70.84.102.91/x/blogquiz.net-blog/1" border="0" width="1" height="1"></div></td></tr></table></td></tr></table>Free <a href="http://www.dailyhoroscopes.biz/">Daily Horoscopes</a> at DailyHoroscopes.Biz</form><br></div>
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This quiz was created by shagadellique (jennifer).
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