NOTE: This application will be incomplete and rejected unless

accompanied by a complete financial statement, job history, lineage,

and current medical report from your doctor.

NAME______________________________________  DATE OF BIRTH______________
HEIGHT____________  WEIGHT_____________  IQ__________  GPA_____________
SOCIAL SECURITY #___________________  DRIVERS LICENSE #________________
BOY SCOUT RANK AND BADGES______________________________________________
HOME ADDRESS__________________________  CITY/STATE___________  ZIP_____
Do you have parents? ___Yes  ___No

If No, explain:

_______________________________________________________________________
Number of years they have been married ________________________________
If less than your age, explain ________________________________________
_______________________________________________________________________
Do you own a van? _______________
A truck with oversized tires? _______________
A waterbed?_______________
A pickup with a mattress in the back?_______________
Do you have an earring, nose ring, or a navel ring? _______________
A tattoo?_______________
(IF YES TO THE ABOVE, DISCONTINUE APPLICATION AND LEAVE PREMISES)
In 50 words or less, what does LATE mean to you?______________________
______________________________________________________________________
______________________________________________________________________
In 50 words or less, what does “DON’T TOUCH MY DAUGHTER” mean to you?
______________________________________________________________________
______________________________________________________________________
In 50 words or less, what does ABSTINENCE mean to you?
______________________________________________________________________
______________________________________________________________________
Church you attend ____________________________________________________
How often you attend _________________________________________________
When would be the best time to interview your:
father? _____________
mother? _____________
pastor? _____________
Answer by filling in the blank.  Please answer freely, all answers are

confidential.
A: If I were shot, the last place I would want shot would be:
_____________________________________________________________________
B: If I were beaten, the last bone I would want broken is my:
_____________________________________________________________________
C: A woman’s place is in the:
_____________________________________________________________________
D: The one thing I hope this application does not ask me about is:
_____________________________________________________________________
What do you want to do IF you grow up? ______________________________
_____________________________________________________________________
_____________________________________________________________________
What is the current going rate of a hotel room? _____________________
I SWEAR THAT ALL INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT TO THE

BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT, NATIVE

AMERICAN ANT TORTURE, CRUCIFIXION, ELECTROCUTION, CHINESE WATER

TORTURE, RED HOT POKERS, AND HILLARY CLINTON KISS TORTURE.
_____________________________________________

Signature (that means sign your name, moron!)
Thank you for your interest.  Please allow four to six years for

processing.
You will be contacted in writing if you are approved.  Please do not

try to call or write (since you probably can’t, and it would cause you

injury). If your application is rejected, you will be notified by two

gentleman wearing white ties carrying violin cases (you might watch

your back).

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