Be On Jerry Springer

Application to go on the Jerry Springer Show:
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
() Exotic Dancer
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:
Number 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 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:
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:
Color of teeth:
() Yellow
() Brownish-Yellow
() Brown
() Black
() N/A

URL: link Added over 3 years ago by http://alan.munsch.myopenid.com/
Tags: application

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