Making a Survey *HELP ME PLEASE*

i have no experience in VB but i have a very simple project im trying to complete

i need to make a program with questions, and blank boxes to right in your answer

after that i need a button on the program to send the information filled out in the survery to my e-mail adress

help? suggestions? need more info?

Oh its already there :P

Down load an example below..most will have the outline needed
Then Post your code in the VBforum

Is this for VB.NET or Classic VB (VB 6)?