NAME______________________________________________ DATE OF BIRTH___________________

HEIGHT________________WEIGHT_________________IQ___________________GPA______________

SOCIAL SECURITY #____________________________DRIVER'S 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 oversize tires?________________________________________________________________

A waterbed?___________________________________________________________________________

A pickup with a mattress in the back?_______________________________________________________

Do you have an earring, nose ring, or a belly button ring?_______________________________________

A tattoo?______________________________________________________________________________

(IF YES TO ANY OF THE ABOVE, DISCONTINUE APPLICATION AND LEAVE THE 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/Religious institution do you attend?___________________________________________________

How often do you attend?________________________________________________________________

When would it be the best time to interview your:

Father?_____________________________

Mother?____________________________

Priest/Pastor?________________________

Answer by filling in the blank. Please answer freely. All answers are kept 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 women's place is in the:

_____________________________________________________________________________________

D: The one thing I hope this application does not ask me about is:

___________________________________________________________________________________________________

E: What do you want to do IF you grow up?

___________________________________________________________________________________________________

F: What is the current rate of a hotel room?

___________________________________________________________________________________________________

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

X__________________________________________________________________________________________________

SIGNATURE (That means sign your name or put your X next to the X)

I AM A NON-DISCRIMINATING FATHER AND TREAT ALL MALES EQUALLY WITHOUT REGARD TO RACE, NATIONALITY, OR RELIGIOUS PREFERENCE. Just remember I am not a woman (Thank God) then I would have to up with suitors like you.

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). BUT IF YOUR APPLICATION IS REJECTED, YOU WILL BE NOTIFIED BY TWO GENTLEMEN WEARING WHITE TIES CARRYING VIOLIN CASES (you might want to reconsider submitting this application).

FYI (For Your Information)

No wise man has ever decided to attempt this fool hardy quest.

If you decide to NOT complete this application and submit it for review (my personal recommendation), PLEASE LEAVE QUIETLY NOW, AND DON'T LET THE DOOR HIT YOU TOO HARD ON THE WAY OUT!

If you are crazy enough to submit this application, then:

Thank you for your interest. Please allow four to six years for processing