How and When will YOU die?
Created by andy and taken 539142 times on Bzoink
Name	<input VALUE="Klia" MAXLENGTH="100" ID="In1" NAME="in1" SIZE="40" TYPE="text" />
Age	<input VALUE="23" MAXLENGTH="100" ID="In2" NAME="in2" SIZE="40" TYPE="text" />
Birth Month	<select VALUE="11" NAME="in3"><option>January</option><option>February</option><option>March</option><option>April</option><option>May</option><option>June</option><option>July</option><option>August</option><option>September</option><option>October</option><option>November</option><option SELECTED="SELECTED">December</option></select>
Die on	September 18, 2056
Die of	Murder
You will feel pain	True
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