Note: This application will be incomplete and rejected unless
accompanied by a complete financial statement, job history,
lineage, and current medical report from your physician.

1. What is your name, age, social security number, IQ and boy scout rank?
2. Do you have one male and one female parent? ____
   If "No", explain:

3. Do you own or have access to a van? ____
4. A truck with oversize tires? ____
5. Waterbed? ____
6. Do you have an earring, nose ring, or belly button ring? ____
7. Do you have a tattoo? ____

*If you have answered YES to #3, #4 or #5, discontinue application and leave immediately.*

8. In fifty words or less, what does LATE mean to you?

9. In fifty words or less, what does DON'T TOUCH MY DAUGHTER mean to you?

10. In fifty words or less, what does ABSTINENCE mean to you?

11. In fifty words or less, what does REAL PAIN mean to you?

12. Church/Temple you attend: ____________________________
13. How often do you attend: ____________________________
14. When would be the best time to interview your mother, father and priest/rabbi? ____________________________
15. Please fill in the blanks:

• If I were shot, the last place on my body I would want wounded would be my ____________________________
• If I were beaten, the last bone I would want broken would be my ____________________________
• A woman's place is in the ____________________________
• The one thing I hope this application doesn't ask is ____________________________
• When I meet a girl, the one thing I always notice about her first is ____________________________

*Note: If answer to last question begins with "T" or "A",
discontinue and leave premises - keeping your head low and
running in a serpentine fashion is advised*

What do you want to be IF you grow up?

I swear that all the above information is correct to the best
of my knowledge under penalty of death, bodily harm,
dismemberment, torture or mental abuse.
Signature of applicant _________________________________
Signature of father _____________________________________
Signature of mother ____________________________________
Signature of priest/rabbi ___________________________________
Signature of State Representative _________________________

Thank you for your interest, and it had better be genuine and
non-sexual. Please allow 4-6 years for processing. You will be
contacted in writing if approved. If denied, please never
apply again. Don't call me, I'll call you.