Name:______________ Stage name:________________
Agent:______________ Attorney:__________________
Sex: ___Male ___Female ___Formerly Male ___Formerly Female
If female, indicate breast implant size: ______
Please list brand of cell phone: __________________. (If you don’t own a cell phone, please explain.)
Please check hair color:
Females: [ ] Blonde [ ] Platinum Blonde
Males: [ ] Shaved [ ] Buzzed [ ] Short hair [ ] Normal (yeah right)
Teenagers: [ ] Purple [ ] Blue [ ] Skinhead
Please check activities you perform while driving: (Check all that apply)
[X] Talking and/or dialing your cell phone (already checked for ease of application)
[ ] Eating
[X] Applying make-up (already checked for ease of application)
[ ] Slapping kids in the backseat
[ ] Having sex
[ ] Applying cellulite treatment to thighs
[ ] Tanning
[ ] Snorting cocaine
[X]Watching TV (already checked for ease of application)
[X] Reading Variety (already checked for ease of application)
[X] Surfing the net via laptop (already checked for ease of application)
Please indicate how many times:
a) you expect to shoot at other drivers ___
b) how many times you expect to be shot by other drivers 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 News 8 Austin 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 through
d) Call your therapist
e) None of the above (Cedar Park residents only).
In the event of a thunderstorm, you should:
a) stop your car
b) keep driving and hope for the best
c) take your vehicle surfing on the IH-35 lower level (IH = Interstate Highway for all you Yankees)
d) immediately use your cell phone to call all loved ones
e) pull out your video camera and obtain footage for News 8 Austin
In the instance of rain, you should:
a) never drive over 10 MPH
b) drive twice as fast as usual
c) 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) Xanex
e) Valium
If none, please explain: _____________________________________________________________________.
Length of daily commute:
a) 1 hour
b) 2 hours
c) 3 hours
d) 4 hours or more
e) not sure, my cell phone battery went dead
When stopped by police, 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 IH-35 (IH = Interstate Highway for all you Yankees)
c) have your video camera ready and provoke them to attack, thus ensuring yourself of a hefty lawsuit
Please turn in your test to the lady behind the bullet-proof window on your left.
This page was last updated on Saturday, 18 March 2006
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