APPLICATION FOR THE JERRY SPRINGER SHOW: > > Personal Information: > Name___________ Nickname______________ CB Handle_____ > > Yore Muma________Yore Diddy (if known)_______ > > Spouse's Name_________ Relationship to spouse: ___Sister____Brother > ____Mother ____Father ___Pet___Aunt ___Uncle > > Occupation: ___Unemployed Mechanic___Gun Show Dealer ___Skinhead > > Number of Children in Household___ Number of children that are yours___ > > Circle Highest Level of Education: 1 2 3 4 > > How Far is Your Mobile Home From a Paved Road?: > ___1mi. __5 mi.? > > Number of Times You Survived a Tornader: ___ > > Number of Vehicles Owned___ Number on Cement Blocks____ > > Truck Equipment: ___Gun Rack ___PitBull ___Spit Cup ___Fuzzy Dice___Rebel > Flag ___Naked Woman Mudflaps ___NWO and/or NRA sticker > > Weapons Owned: ___Tire Iron ___Pick Handle ___Beer Bottle ___Shotgun > > Number of Dogs Owned: ___ Number of Homemade Tattoos: ___ > > Which of the Following Appliances are in your Front Yard?: ___Friggerator > ___Heatin Stove___Warsher ___TV ___Freezer How Many of the Above Appliances > Work?: ___ > > Fav-o-rite Recreation: ___Drinkin___Cow Chip Throwin ___Possum Huntin > ___Crawdad Huntin ___Spittin Backy___Scratchin ___Watchin Wrasslin > > If You Can Read, Which Magazines Do You Prefer?: > ___Soap Opera Digest ___ Rifle and Shotgun ___NWO ___TV Guide ___National > Enquirer___True Confessions ___Soldier of Fortune __Mini Trucker > > Which Stinks Warse?: ___Hogpen___Outhouse ___Spouse > > Can You Spell Your Last Name?:___Yup___Nope > > Can You Remember Your Last Name?:___Yup ___Nope > > Ever Stayed Sober for More'n a Day?:___Yup ___Nope > > Do You Know Any Words with More'n 4 Letters?: ___Yup ___Nope > > Which is Correct?: ___"I Seed Him" or ___"I Seen Him" > > How Many Cartons of Cigarettes Do You Smoke a Day? > ___ > > Math Test: How Many Food Stamps Do the Following Cost? > ___Six Pack ___Ciggies ___Shotgun Shells ___Backy ___Prostitute > > Number of Times You've Seen: ___a UFO ___ Elvis ___Elvis in a UFO > > Health Questionaire: Which of the Following Do You Have? ___Head Lice > ___B.O. ___Crabs___Runny Nose ___Boils > > Can You Remember the Last Time You Done Bathed? > ___Yup ___Nope > > Color of Teeth: ___Yellow ___Brown___Black ___N/A > > I hereby swear this is the trooth and sign my "X" on _________