Simply fill in this 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
       (_) Anne_Louise
       
       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
       
       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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