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|colspan=3 class="q4"|''{{{text|}}}
 
|colspan=3 class="q4"|''{{{text|}}}
|colspan=4 rowspan=3|{{{other|}}}{{{#if:{{{other|}}}|<br>}}}{{{#if:{{{Choice1|}}}|'''Choose between:'''<br>}}}{{{Choice1|}}}<br>{{{#if:{{{Choice2|}}}|'''Then choose between:'''<br>}}}{{{Choice2|}}}
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|colspan=4 rowspan=3|{{{Other|}}}{{{#if:{{{Other|}}}|<br>}}}{{{#if:{{{Choice1|}}}|'''Choose between:'''<br>}}}{{{Choice1|}}}<br>{{{#if:{{{Choice2|}}}|'''Then choose between:'''<br>}}}{{{Choice2|}}}
 
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|colspan=3 class="q4"|{{{req|}}}
 
|colspan=3 class="q4"|{{{req|}}}
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