{assign var="pgLayout" value="file:./layouts/lite.tpl"}
<h2 class="withBG">Survey #10203 - Week 7 - Day 3</h2>
<form name="surveyForm" action="index.php" method="POST">
<input type="hidden" name="pg" value="{$page.name}" />
<ol id="surveyQuestionList">
	<li>Please choose one of the following:
	<dl>
		<dt><input type="radio" name="q1" value=""> Option 1</dt>
		<dt><input type="radio" name="q1" value=""> Option 2</dt>
		<dt><input type="radio" name="q1" value=""> Option 3</dt>
		<dt><input type="radio" name="q1" value=""> Option 4</dt>
	</dl></li>
	<li>Please choose one of the following:
	<dl>
		<dt><input type="radio" name="q1" value=""> Option 1</dt>
		<dt><input type="radio" name="q1" value=""> Option 2</dt>
		<dt><input type="radio" name="q1" value=""> Option 3</dt>
		<dt><input type="radio" name="q1" value=""> Option 4</dt>
	</dl></li>
	<li>Please choose one of the following:
	<dl>
		<dt><input type="radio" name="q1" value=""> Option 1</dt>
		<dt><input type="radio" name="q1" value=""> Option 2</dt>
		<dt><input type="radio" name="q1" value=""> Option 3</dt>
		<dt><input type="radio" name="q1" value=""> Option 4</dt>
	</dl></li>
	<li>Please choose one of the following:
	<dl>
		<dt><input type="radio" name="q1" value=""> Option 1</dt>
		<dt><input type="radio" name="q1" value=""> Option 2</dt>
		<dt><input type="radio" name="q1" value=""> Option 3</dt>
		<dt><input type="radio" name="q1" value=""> Option 4</dt>
	</dl></li>
</ol>

<input type="submit" value="Submit Responses" />
</form>
