Please fill in my simple survey

Please tell me your name: (Do not hit return - this will send the form.)

Please enter your e-mail address:

1) How old are you?
Under 18 years old
Between 18 and 24 years old
Between 25 and 34 years old
Between 35 and 44 years old
More than 44 years old
2) How often do you visit my page?
Every Day
Every Week
Once per month
Once per year
3) What are your favourite drinks?
You may select more than one.
Coca Cola
Coffee
Tea
Milk
Beer
Wine
4) Please provide your comments about my page
5) What do you think of this Forms Class?