Name: _______________ Stage name: ________________

 Agent: ______________ Attorney: __________________

 Sex:  ___male  ___female  ___formerly male  ___formerly female  ___both
       
If female, indicate breast implant size: ____

 Will the size of your implants hinder your ability to safely  operate a motor vehicle in any way?   Yes___ No ___

Please list brand of cell phone: __________________
 (If you don't own a cell phone, please explain.)

 
Please check hair color:
 Females:   [ ] Blonde  [ ] Platinum Blonde
 Teenagers: [ ] Purple  [ ] Blue  [ ] Skinhead

 
Please indicate activities you perform while driving:
 Check all that apply)
 [ ] Eating
 [ ] Applying make-up
 [ ] Talking on the phone
 [ ] Slapping kids in the back seat
 [ ] Applying cellulite treatment to thighs
 [ ] Tanning
 [X] Snorting cocaine (already checked for ease of application)
 [ ] Watching TV
 [ ] Reading Variety magazine
 [ ] Surfing the net via laptop

 
Please indicate how many times
 a) You expect to shoot at other drivers: _____
 b) How many times you expect to be shot at while driving: _____

 
Please indicate your number of therapy sessions per week: ____

 
Are you presently taking any of the following medications?
 a) Prozac
 b) Zovirax
 c) Lithium
 d) Zanax
 e) Valium
 If none, please explain: _______________________________

 
What is the length of your daily commute?
 a) 1 hour
 b) 2 hours
 c) 3 hours
 d) 4 hours or more


TEST (Please indicate the correct answer):

 If you are the victim of a car jacking, you should immediately:
 a) Call the police to report the crime
 b) Call Channel 4 News to report the crime, then watch your
    car on TV in a high-speed chase
 c) Call your attorney and discuss a lawsuit against the cellular
    phone company for your 911 call not going through
 d) Call your therapist
 e) None of the above (South Central residents only)

 
In the event of an earthquake, you should:
 a) Stop your car
 b) Keep driving and hope for the best
 c) Immediately use your cell phone to call all loved ones
 d) Pull out your video camera and obtain footage for Channel 4

In the event of rain, you should:
 a) Never drive over 5 MPH
 b) Drive twice as fast as usual
 c) You're not sure what "rain" is

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 the 405
 c) Have your video camera ready and provoke them to attack,
    ensuring yourself of a hefty lawsuit

Please turn your test in to the lady behind the bulletproof
virtual window on your left.