Mine

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<title>IWSD Prac Set 2 - Task 2 - Autumn 2007</title>
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<h1> Get Me Fit Quick - Quick Member Survey </h1>

<p> Please take a minute to fill in the form below. We value your feedback - thanks. <p>

<p> 
<ol> 
<li> <form method="post" id="form" action="http://tl28serv.uws.edu.au/iwsdinfo/form.asp"> 
How many times per week have you visited our Gymnasium since becoming a member?
<br />
<input type="radio" name="visitsperweek" value="one" /> Once per week <br />
<input type="radio" name="visitsperweek" value="two" /> Twice per week <br />
<input type="radio" name="visitsperweek" value="three" /> Three times per week <br />
<input type="radio" name="visitsperweek" value="greaterthanfour" /> Four or more times per week <br />
<input type="radio" name="visitsperweek" value="none" /> I have not visited since joining (sigh) <br />
</li>

<li> Which of our classes have you attended? <br />
<input type="checkbox" name="whichclassesattended" value="aerobics" /> Aerobics <br />
<input type="checkbox" name="whichclassesattended" value="boxing" /> Boxing <br />
<input type="checkbox" name="whichclassesattended" value="circuit" /> Circuit Class <br />
<input type="checkbox" name="whichclassesattended" value="weights" /> Weight Training <br />
</li>

<li> Which of the above classes has been <strong>most</strong> beneficial for you? <br />
(You can only choose one from the list): <select name="beneficialclass" class="butts"> 
<option value="notchosen">--Please choose one--</option>
<option value="aerobics">Aerobics</option> 
<option value="boxing">Boxing</option> 
<option value="circuit">Circuit Class</option> 
<option value="weights">Weight Training</option>
</select>
</li>
<li> Do you believe you are receiving good value for money from your membership? <br />
<input type="radio" name="valueformembership" value="yes"> Yes <br />
<input type="radio" name="valueformembership" value="no"> No <br />
</li>
<li> If you answered YES to the question above, how much <strong>MORE</strong> would you be willing to pay for your membership? <br />
$<input type="textbox" class="txtbox" name="paymore" />

</li>
</ol>

Your Date <input type="textbox" name="box1" id="box1" disabled="disabled" /> 



<br />
<br />
<br />
<input type="submit" class="butts" value="Finished Survey" /> <input type="reset" class="butts" value="Reset Survey" />
</form>


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