document.write('<form method=post action=http://poll.pollhost.com/vote.cgi>');
document.write('<table border=0 width=150 bgcolor=#FFFFFF cellspacing=0 cellpadding=2>');
document.write('<tr><td colspan=2><font face="Arial" size=-1 color="#000000"><b>What are you wearing?  [select all that apply]</b></td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=1></td><td><font face="Arial" size=-1 color="#000000">Shoes</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=2></td><td><font face="Arial" size=-1 color="#000000">Socks</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=3></td><td><font face="Arial" size=-1 color="#000000">Pants/Shorts</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=4></td><td><font face="Arial" size=-1 color="#000000">Skirt</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=5></td><td><font face="Arial" size=-1 color="#000000">Underwear</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=6></td><td><font face="Arial" size=-1 color="#000000">Tee-Shirt</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=7></td><td><font face="Arial" size=-1 color="#000000">Hat</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=8></td><td><font face="Arial" size=-1 color="#000000">Gloves</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=9></td><td><font face="Arial" size=-1 color="#000000">Legwarmers</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=10></td><td><font face="Arial" size=-1 color="#000000">Scarf</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=11></td><td><font face="Arial" size=-1 color="#000000">Jewelry</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=12></td><td><font face="Arial" size=-1 color="#000000">Bra</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=13></td><td><font face="Arial" size=-1 color="#000000">Vest</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=14></td><td><font face="Arial" size=-1 color="#000000">Glasses/Contact Lenses</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=15></td><td><font face="Arial" size=-1 color="#000000">Hooded Sweatshirt</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=16></td><td><font face="Arial" size=-1 color="#000000">Non-Hooded Sweatshirt</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=17></td><td><font face="Arial" size=-1 color="#000000">Sweater</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=18></td><td><font face="Arial" size=-1 color="#000000">Jacket</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=19></td><td><font face="Arial" size=-1 color="#000000">Tie</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=20></td><td><font face="Arial" size=-1 color="#000000">Food</td></tr>');
document.write('<tr><td colspan=2>');
document.write('<input type=hidden name=username value="Xopher">');
document.write('<input type=hidden name=poll value="1155535145">');
document.write('<input type=hidden name=background value="FFFFFF">');
document.write('<input type=hidden name=font_color value="000000">');
document.write('<input type=hidden name=font_face value="Arial">');
document.write('<input type=hidden name=bars value="Assorted">');
document.write('<center><input type=submit value=Vote>');document.write('&nbsp;&nbsp;<input type=submit name=view value=View>');
document.write('</center>');
document.write('</td></tr>');
document.write('<tr><td bgcolor=#FFFFFF colspan=2 align=right><font face="Arial" size=-2 color="#000000"><a href=http://www.pollhost.com/><font color=#000099>Free polls from Pollhost.com</font></a></td></tr>');
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