KAOS2000 Magazine Backpages: Jerry Springer Show Guest Application

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Jerry Springer Show Guest Application

Personal Information:

Name___________ Nickname______________ CB Handle______________ Yore Mama______________ Yore Daddy (if known)________________ Spouse's Name_________________ Relationship to spouse: __Sister _ Brother__Mother__Father _Pet _Aunt _Uncle Other "Significant Other's" Name_________________ Occupation: ___Unemployed Mechanic ___Gun Show ____Dealer ___Skinhead Number of Children in Household___
Number 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 Have Survived a Tornado: ___ Number of Vehicles Owned___ Number on Cement Blocks___ Truck Equipment: ___Gun Rack ___Pit Bull ___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 ___NWA ___Rifle and Shotgun ___TV Guide __ National Enquirer __True Confessions Which Stinks Worse: ___Hogpen ___Outhouse ___Spouse Can You Spell Your Last Name:___Yup ___Nope Can You Remember Your Last Name: ___Yup ___Nope Have You Ever Stayed Sober for More Than One Day: ___Yup ___Nope Do You Know Any Words with More Than 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 Bathed? ___Yup___Nope Color of Teeth: ___Yellow ___Brown ___Black ___N/A I hereby swear this is the trooth and sign my "X" on _________

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