(English version) Name:__________ Stage name:__________Agent:___________ Attorney:__________Sex: ___male ___female ___formerly male ___formerly female ___both If female, indicate breast implant size: ____Will the size of your implants hinder your ability to safely operate a motor vehicle in any way? Yes___ No ___ Brand of cell phone: ________. (If you don't own a cell phone, please explain.) Please check hair color: Females: __ Blonde __ Platinum Blonde Teenagers:__Billy Idol __ Purple __ Mixed __ Skinhead Please check activities you perform while driving: (Check all that apply)__ Eating __ Applying make-up __ Talking on the phone __ Slapping kids in the backseat __ Having sex __ Applying cellulite treatment to thighs __ TanningX Snorting cocaine (already checked for ease of application)__Watching TV __ Reading Variety__ Surfing the net via laptop Please indicate how many times:a) you expect to shoot at other drivers __ b) how many times you expect to be shot at while driving __ TEST If you are the victim of a car jacking, you should immediately: a) Call the police to report the crime b) Call Channel 4 News to report the crime, then watch your car on the news on a high-speed chase c) Call your attorney and discuss lawsuit against cellular phone company for 911 call not going throughd) Call your therapist e) None of the above (South Central residents only) In the event of an earthquake, should you: a) stop your car b) keep driving and hope for the best c) immediately use your cell phone to call all loved ones d) pull out your video camera and obtain footage for Channel 4? In the instance of rain, you should:a) never drive over 5 MPH b) drive twice as fast as usualc) you're not sure what "rain" is. Please indicate number of therapy sessions per week: ____. Are you presently taking any of the following medications? a) Prozac b) Zovirax c) Lithium d) Zanax e) Valium If none, please explain: _____ Length of daily commute: a) 2 hours b) 3 hours c) 4 hours or more When stopped by police, should you should: a) pull over and have your driver's license and insurance form ready b) try to outrun them by driving the wrong way on the 405 c) have your video camera ready and provoke them to attack, thus ensuring yourself of a hefty lawsuit? Thanks Joana for sending me this!
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