Application to go on the Jerry Springer Show

> >Application to go on the Jerry Springer Show ============================================
> > Last name: ________________
> > First name: (Check appropriate box)
> > (_) Billy-Bob
> > (_) Billy-Joe
> > (_) Billy-Ray
> > (_) Billy-Sue
> > (_) Billy-Mae
> > (_) Billy-Jack
> >
> > What does everyone call you?
> > (_) Booger
> > (_) Bubba
> > (_) Junior
> > (_) Sissy
> > (_) Other___________________
> > Age: ____ (if unsure, guess) _____ Not sure
> > Shoe Size: ____ Left ____ Right
> > Occupation: (Check appropriate box)
> > (_) Farmer
> > (_) Mechanic
> > (_) Hair Dresser
> > (_) Unemployed
> > (_) Dirty Politician
> > (_) Preacher
> > (_) Strip Dancer
> > (_) Hooker
> > Spouse's Name:_________________________
> > 2nd Spouse's Name:______________________
> > 3rd Spouse's Name:______________________
> > Lover's Name:___________________________
> >
> > Relationship with spouse: (Check appropriate box)
> > (_) Sister
> > (_) Brother
> > (_) Aunt
> > (_) Uncle
> > (_) Cousin
> > (_) Mother
> > (_) Father
> > (_) Son
> > (_) Daughter
> > (_) Pet
> >
> > Number of children living in household: _____
> > Number of children living in shed: ______
> > Numbers that are yours: ______
> >
> > Mother's Name: _______________________(If not sure, leave blank)
> > Father's Name: _______________________(If not sure, leave blank)
> >
> > Education: 1 2 3 4 (Circle highest grade completed)
> >
> > Total number of vehicles you own: ___
> > Number of vehicles that still crank: ___
> > Number of vehicles in front yard: ___
> > Number of vehicles in back yard: ___
> > Number of vehicles on cement blocks: ___
> >
> > Firearms you own and where you keep them:
> > ____ truck
> > ____ bedroom
> > ____ bathroom
> > ____ kitchen
> > ____ shed
> >
> > Model and year of your pickup: 196_
> >
> > Do you have a gun rack?
> > If no, please explain:
> >
> > Newspapers/magazines you subscribe to:
> > (_) The National Enquirer
> > (_) The Globe
> > (_) TV Guide
> > (_) Soap Opera Digest
> > (_) Rifle and Shotgun
> >
> > Number of times you've seen a UFO:_____
> > Number of times in the last 5 years you've seen Elvis:_____
> > Number of times you've seen Elvis in a UFO:_____
> >
> > How often do you bathe:
> > (_) Weekly
> > (_) Monthly
> > (_) Not Applicable
> >
> > Colour of eyes:
> > Right_____ left_____
> >
> > Colour of hair:
> > (_) Blond
> > (_) Black
> > (_) Red
> > (_) Brown
> > (_) White
> > (_) Clairol
> > Colour of teeth:
> > (_) Yellow
> > (_) Brownish-Yellow
> > (_) Brown
> > (_) Black
> > (_) N/A
> > Brand of chewing tobacco you prefer:
> > (_)Red-Man
> >
> > How far is your home from a paved road?
> > (_) 1 mile
> > (_) 2 miles
> > (_) Just a whoop-and-a-holler!
> > (_) road?