This certifies that I, the undersigned male is about to give my body voluntarily in a sexual intercourse with _____________________________________, and I am above the lawful age of consent, and am in my right mind and not under the influence of any known alcohol or narcotic. Neither does she have to use any force, threats or promises to influence me. I am in no fear of her whatever: do not expect or want to marry her, don't know whether she is married or not, and don't care. I am not asleep or drunk, and am entering into this relation with her because I love it and want it as much as she does, and if I receive the satisfaction I expect, I am willing to consider an early return engagement. To the best of my knowledge, I am free of sexually transmitted diseases, headlice or pests. Furthermore, I agree never to appear as a witness against her or prosecute her under the Man Slave act. Signed before jumping into her bed this day ____ of _________ 19_____ Signed____________________________________________Age__________ Address________________________________________________________ _______________________________________________________________ Next Of Kin_____________________________________________________ Phone Number_________________________________________________

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