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?
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
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 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
Color of eyes:
Right:
Left:
Color of hair:
Blond
Black
Red
Brown
White
Clairol
Color 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?
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