Karenluvs6
11-05-2000, 05:16 PM
GUEST APPLICATION FOR 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 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
__ Nekkid Wimmen Mudflaps
__ NRA sticker
Weapons Owned:
__ Tire Iron
__ Pick Handle
__ Beer Bottle
__ Shotgun
Number of Dogs Owned: ___
Number of Homemade Tattoos: ___
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:
__ Drankin'
__ Cow Chip Throwin'
__ Possum Huntin'
__ Crawdad Huntin'
__ Spittin' Backy
__ Scratchin'
__ Watchin- Wrasslin'
IF you can read, which magazines do you prefer:
__ Soap Opera Digest
__ NWA
__ Rifle and Shotgun
__ TV Guide
__ National Enquirer
__ True Confessions
Which Stinks Worse?
__ Hogpen
__ Outhose
__ Spouse
Can you spell your last name?
__ Yep
__ Nope
Can you REMEMBER your last name?
__ Yep
__ Nope
Have you ever stayed sober for more than one day?
__ Yep
__ Nope
Do you know any words with more than 4 letters?
__ Yep
__ Nope
Which is correct?
__ "I seed him"
__ "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 of Coors
__ Ciggies
__ Shotgun shells
__ Backy
__ Prostitute
Number of times you've seen:
__ A UFO
__ Elvis
__ Elvis in a UFO
Health: Which of the following do you have?
__ Head Lice
__ B.O.
__ Crabs
__ Runny Nose
__ Boils
Can you remember the last time you bathed?
__ Yep
__ Nope
Color of teeth:
__ Yeller
__ Black
__ Brown
__ N/A
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 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
__ Nekkid Wimmen Mudflaps
__ NRA sticker
Weapons Owned:
__ Tire Iron
__ Pick Handle
__ Beer Bottle
__ Shotgun
Number of Dogs Owned: ___
Number of Homemade Tattoos: ___
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:
__ Drankin'
__ Cow Chip Throwin'
__ Possum Huntin'
__ Crawdad Huntin'
__ Spittin' Backy
__ Scratchin'
__ Watchin- Wrasslin'
IF you can read, which magazines do you prefer:
__ Soap Opera Digest
__ NWA
__ Rifle and Shotgun
__ TV Guide
__ National Enquirer
__ True Confessions
Which Stinks Worse?
__ Hogpen
__ Outhose
__ Spouse
Can you spell your last name?
__ Yep
__ Nope
Can you REMEMBER your last name?
__ Yep
__ Nope
Have you ever stayed sober for more than one day?
__ Yep
__ Nope
Do you know any words with more than 4 letters?
__ Yep
__ Nope
Which is correct?
__ "I seed him"
__ "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 of Coors
__ Ciggies
__ Shotgun shells
__ Backy
__ Prostitute
Number of times you've seen:
__ A UFO
__ Elvis
__ Elvis in a UFO
Health: Which of the following do you have?
__ Head Lice
__ B.O.
__ Crabs
__ Runny Nose
__ Boils
Can you remember the last time you bathed?
__ Yep
__ Nope
Color of teeth:
__ Yeller
__ Black
__ Brown
__ N/A