Weird, still no luck for me.
Your input generated the following error:
null
Please use your browser's back button to correct the problem and resubmit the data.
The only empty field in my submission is one that they provide:
<FORM NAME="survey" ACTION="submitsurvey.jsp" METHOD="POST">
<INPUT TYPE="HIDDEN" NAME="SurveyID" VALUE="0ebd221586200">
<INPUT TYPE="HIDDEN" NAME="charset" VALUE="Cp1252">
<INPUT TYPE="HIDDEN" NAME="locale" VALUE="en_US">
<INPUT TYPE="HIDDEN" NAME="PC" VALUE="">