1.NAME ______________________________Date of Birth _____________

2.HEIGHT ________WEIGHT ________I.Q.________G.P.A.________

3.SOCIAL SECURITY # ________________DRIVER'S LICENSE#_______________

4.BOY SCOUT RANK __________________________________________________

5.HOME ADDRESS ______________________ CITY/STATE _________ZIP _____

6.Do you have one MALE and one FEMALE parent?_____

IF NO, EXPLAIN: _____________________________________________________

7.Number of years parents married?_________________________________________

8.Do you own a van?_____A truck with oversized tires?_____A waterbed?_____

Do you have an earring, nose ring, or bellybutton ring?_____ A Tattoo?_____

9.In 50 words or less, what does Late mean to you?___________________________________

10.In 50 words or less, what does DON'T TOUCH MY DAUGHTER mean to you? ________________________________________________________________________________________

11.In 50 words or less, what does ABSTINENCE mean to you? _____________________________________________________________________________________________________

12.Church you attend:____________________ How often do you attend? ____________________

When would be the best time to interview your mother, father, and priest/minister? __________

ANSWER BY FILLING IN THE BLANK: Please answer freely - all answers are confidential

(This means I won't tell anyone ever- I promise)

A.If I were shot, the last place on my body I would want to be wounded is in the _______________

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 is ______________________________

E.When I first meet a girl, the thing I notice about her is _______________________________

NOTE: If answer to E above begins with T or A, discontinue and leave premise keeping your head low, running in a serpentine fashion is advised.

What do you want to be IF you grow up?__________________________________________

I SWEAR THAT ALL INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT, FIRE ANT TORTURE CRUCIFIXION, ELECTROCUTION, WATER TORTURE, RED HOT POKERS, AND HILLARY KISS TORTURE.

SIGNATURE (That means, sign your name moron) & DATE

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 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 gentlemen wearing white ties and carrying violin cases (you might want to watch your back).