·····THIS CERTIFIES, that the undersigned male about to enjoy sexual intercourse with....................... am above the lawful age of consent, am in my right mind and not under the influence of any drug or narcotic. Neither does she have to use any force, threats or promises to influence me.
······I am in no fear of her whatever, do not expect or want to marry her, don't know whether she is married or not, and don't give a damn; I am not asleep or drunk, and am entering into this relationship with her because I love it and want it as much as she does and if I receive the satisfaction I expect, I am willing for an early return engagement. Furthermore, I agree never to appear as a witness against her or prosecute under Mann White Slave Act.
·····SIGNED before jumping into bed, this .......... day of ................, 20....
BY.......................................