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Name:______________ Stage name: ________________
Agent: ______________
Attorney: __________________
Sex: male ____ female _____ formerly male_______ formerly female
__________
both ___________
If female, indicate breast implant size: ____
Will the size of your implants hinder your ability to safely operate a
motor
vehicle in any way? Yes___ No ___
Occupation:
[ ] Lawyer
[ ] Actor/Waiter
[ ] Film-maker/Self-employed
[ ] Writer
[ ] Car Dealer
[ ] Pan-handler
[ ] Agent
[ ] Hooker/Transvestite
[ ] Other; please explain:
Please indicate how many times you expect to have sex in a car________
Please indicate how much you plan to spend for this sex ________
Brand of cell phone: __________. (If you don't own a cell phone, please
explain.)
Please check hair color:
Females: [ ] Blonde [ ] Platinum Blonde
Teenagers: [ ] Purple [ ] Blue [ ] Skinhead
Men: Please list shade of hair-plugs: _____________________
Please check activities you perform while driving: (Check all that
apply)
[ ] Eating a wrap
[ ] Applying make-up
[ ] Talking on the phone
[ ] Slapping kids in the backseat
[ ] Having sex
[ ] Applying cellulite treatment to thighs
[ ] Tanning
[ ] Snorting cocaine
[ ] Watching TV
[ ] Reading Variety
[ ] Surfing the net via laptop
Please indicate how many times:
a) you expect to shoot at other drivers, and
b) how many times you expect to be shot at while driving.
If you are the victim of a car-jacking, you should immediately:
a) Call the police to report the crime;
b) Call Channel 4 News to report the crime, then watch your car on the
news on a high-speed chase;
c) Call your attorney and discuss lawsuit against cellular phone company
for 911 call not going through
d) Call your therapist
e) None of the above (South Central resident)
Please indicate if you drive:
a) a Beamer
b) a Lexus
c) a Mercedes
d) Cabriolet
If your answer is D, please add six to eight weeks to normal delivery
time for your driver's license.
In the event of an earthquake, should you:
a) stop your car
b) keep driving and hope for the best
c) immediately use your cell phone to call all loved ones
d) pull out your video camera and obtain footage for Channel 4
In the instance of rain, you should:
a) never drive over 5 MPH
b) drive twice as fast as usual
c) you're not sure what "rain" is
Please indicate number of therapy sessions per week:____.
Are you presently taking any of the following medications?
a) Prozac
b) Zovirax
c) Lithium
d) Zanax.
If none, please explain: _____________________
Length of daily commute:
a) 1 hour
b) 2 hours
c) 3 hours
d) 4 hours or more
When stopped by police, should you
a) pull over and have your driver's license and have insurance form
ready
b) try to outrun them by driving the wrong way on the 405
c) have your video camera ready and provoke them to attack, thus
ensuring yourself of a hefty lawsuit?
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