GUEST APPLICATION FOR THE JERRY SPRINGER SHOW



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

Occupation: ___Unemployed Mechanic ___Gun Show Dealer ___Skinhead

Number of Children in Household: ___ Number of children 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 Tattoo: ___

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___ Rifle and Shotgun ___NWA ___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 CorrectA: ___"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 and sign my "X" on _________200__

You're best work UK.

Thats funny!!!

where's the question if we want beads. and what we have to do for them....hehehehehe

cool

That's great!!!

What will you do, now that you're retired.

J/K I'm sure you can top that, but it WILL be harder now!!

Know some folks like that!