Want to be on Jerry Springer? - Tilted Forum Project Discussion Community

Munku · 07-07-2003, 09:22 AM

Then Fill this baby out!

Last name: ________________
First name: (Check appropriate box)
(_) Billy-Bob
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-Jack

What does everyone call you?
(_) Booger
(_) Bubba
(_) Junior
(_) Sissy
(_) Other___________________

Age: ____ (if unsure, guess) _____ Not sure
Shoe Size: ____ Left ____ Right
Occupation: (Check appropriate box)
(_) Farmer
(_) Mechanic
(_) Hair Dresser
(_) Unemployed
(_) Dirty Politician
(_) Preacher
(_) Strip Dancer
(_) Hooker

Spouse's Name:_________________________
2nd Spouse's Name:______________________
3rd Spouse's Name:______________________
Lover's Name:___________________________

Relationship with spouse: (Check appropriate box)
(_) Sister
(_) Brother
(_) Aunt
(_) Uncle
(_) Cousin
(_) Mother
(_) Father
(_) Son
(_) Daughter
(_) Pet

Number of children living in household: _____
Number of children living in shed: ______
Numbers that are yours: ______

Mother's Name: _______________________(If not sure, leave blank)
Father's Name: _______________________(If not sure, leave blank)

Education: 1 2 3 4 (Circle highest grade completed)

Total number of vehicles you own: ___
Number of vehicles that still crank: ___
Number of vehicles in front yard: ___
Number of vehicles in back yard: ___
Number of vehicles on cement blocks: ___

Firearms you own and where you keep them:
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shed

Model and year of your pickup: 196_

Do you have a gun rack?
If no, please explain:

Newspapers/magazines you subscribe to:
(_) The National Enquirer
(_) The Globe
(_) TV Guide
(_) Soap Opera Digest
(_) Rifle and Shotgun

Number of times you've seen a UFO:_____
Number of times in the last 5 years you've seen Elvis:_____
Number of times you've seen Elvis in a UFO:_____

How often do you bathe:
(_) Weekly
(_) Monthly
(_) Not Applicable

Colour of eyes:
Right_____ left_____

Colour of hair:
(_) Blond
(_) Black
(_) Red
(_) Brown
(_) White
(_) Clairol
Colour of teeth:
(_) Yellow
(_) Brownish-Yellow
(_) Brown
(_) Black
(_) N/A
Brand of chewing tobacco you prefer:
(_)Red-Man

How far is your home from a paved road?
(_) 1 mile
(_) 2 miles
(_) Just a whoop-and-a-holler!
(_) road?

Conclamo Ludus · 07-07-2003, 09:51 AM

Nice.

troit · 07-07-2003, 11:25 AM

Yeah -- if you ever get a free trip to Chicago but don't know why -- let me help you figure it out.....

Never understood why people would go on national telvision to air their dirty laundry...

The_Dude · 07-07-2003, 11:28 AM

that relagionship w/ spouse thing really cracked me up.

gave pet as a choice

bundy · 07-07-2003, 07:38 PM

thats classic.
wonder just how close that is to the real questionaire/contract??

07-07-2003, 09:22 AM	#1 (permalink)
Munku Lost Location: Florida	Want to be on Jerry Springer? Then Fill this baby out! Last name: ________________ First name: (Check appropriate box) (_) Billy-Bob (_) Billy-Joe (_) Billy-Ray (_) Billy-Sue (_) Billy-Mae (_) Billy-Jack What does everyone call you? (_) Booger (_) Bubba (_) Junior (_) Sissy (_) Other___________________ Age: ____ (if unsure, guess) _____ Not sure Shoe Size: ____ Left ____ Right Occupation: (Check appropriate box) (_) Farmer (_) Mechanic (_) Hair Dresser (_) Unemployed (_) Dirty Politician (_) Preacher (_) Strip Dancer (_) Hooker Spouse's Name:_________________________ 2nd Spouse's Name:______________________ 3rd Spouse's Name:______________________ Lover's Name:___________________________ Relationship with spouse: (Check appropriate box) (_) Sister (_) Brother (_) Aunt (_) Uncle (_) Cousin (_) Mother (_) Father (_) Son (_) Daughter (_) Pet Number of children living in household: _____ Number of children living in shed: ______ Numbers that are yours: ______ Mother's Name: _______________________(If not sure, leave blank) Father's Name: _______________________(If not sure, leave blank) Education: 1 2 3 4 (Circle highest grade completed) Total number of vehicles you own: ___ Number of vehicles that still crank: ___ Number of vehicles in front yard: ___ Number of vehicles in back yard: ___ Number of vehicles on cement blocks: ___ Firearms you own and where you keep them: ____ truck ____ bedroom ____ bathroom ____ kitchen ____ shed Model and year of your pickup: 196_ Do you have a gun rack? If no, please explain: Newspapers/magazines you subscribe to: (_) The National Enquirer (_) The Globe (_) TV Guide (_) Soap Opera Digest (_) Rifle and Shotgun Number of times you've seen a UFO:_____ Number of times in the last 5 years you've seen Elvis:_____ Number of times you've seen Elvis in a UFO:_____ How often do you bathe: (_) Weekly (_) Monthly (_) Not Applicable Colour of eyes: Right_____ left_____ Colour of hair: (_) Blond (_) Black (_) Red (_) Brown (_) White (_) Clairol Colour of teeth: (_) Yellow (_) Brownish-Yellow (_) Brown (_) Black (_) N/A Brand of chewing tobacco you prefer: (_)Red-Man How far is your home from a paved road? (_) 1 mile (_) 2 miles (_) Just a whoop-and-a-holler! (_) road?

07-07-2003, 09:51 AM	#2 (permalink)
Conclamo Ludus Modern Man Location: West Michigan	Nice. __________________ Lord, have mercy on my wicked soul I wouldn't mistreat you baby, for my weight in gold. -Son House, Death Letter Blues

07-07-2003, 11:25 AM	#3 (permalink)
troit Transfer Agent Location: NYC	Yeah -- if you ever get a free trip to Chicago but don't know why -- let me help you figure it out..... Never understood why people would go on national telvision to air their dirty laundry... __________________ I've yet to dephile myself...

07-07-2003, 11:28 AM	#4 (permalink)
The_Dude The GrandDaddy of them all! Location: Austin, TX	that relagionship w/ spouse thing really cracked me up. gave pet as a choice __________________ "Luck is what happens when preparation meets opportunity." - Darrel K Royal

07-07-2003, 07:38 PM	#5 (permalink)
bundy . Location: Tokyo	thats classic. wonder just how close that is to the real questionaire/contract?? __________________ Ohayo!!!