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document.write('<tr><td colspan=2><font face="Comic Sans MS" size=-1 color="#880000"><b>What would you like to see in survivor packs?</b></td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=1></td><td><font face="Comic Sans MS" size=-1 color="#880000">Hand Santizer wipes</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=2></td><td><font face="Comic Sans MS" size=-1 color="#880000">Mini folding brush and comb</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=3></td><td><font face="Comic Sans MS" size=-1 color="#880000">Compact mirror and brush</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=4></td><td><font face="Comic Sans MS" size=-1 color="#880000">Degree Women Deodorant</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=5></td><td><font face="Comic Sans MS" size=-1 color="#880000">Soft and Dri Women\'s Deodorant</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=6></td><td><font face="Comic Sans MS" size=-1 color="#880000">Safety Pins</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=7></td><td><font face="Comic Sans MS" size=-1 color="#880000">Mouthwash</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=8></td><td><font face="Comic Sans MS" size=-1 color="#880000">Tylenol Extra Strength</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=9></td><td><font face="Comic Sans MS" size=-1 color="#880000">Glitter Spray</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=10></td><td><font face="Comic Sans MS" size=-1 color="#880000">Tampon</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=11></td><td><font face="Comic Sans MS" size=-1 color="#880000">Sanitary Napkin</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=12></td><td><font face="Comic Sans MS" size=-1 color="#880000">Panty Shields</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=13></td><td><font face="Comic Sans MS" size=-1 color="#880000">Feminine Wipes</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=14></td><td><font face="Comic Sans MS" size=-1 color="#880000">Clean and Clear Oil Blotting Sheets</td></tr>');
document.write('<tr><td width=5><input type=checkbox name=answer value=15></td><td><font face="Comic Sans MS" size=-1 color="#880000">Neutrogena Sunblock SPF 55</td></tr>');
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document.write('<input type=hidden name=username value="mimi007">');
document.write('<input type=hidden name=poll value="1245036314">');
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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>');
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document.write('</td></tr>');
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