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.