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Application Form For The Jerry Springer Show Last name: ________________ First name: (Tick appropriate box) What does everyone call you? Age: ____ (if unsure, guess) _____ Not sure Shoe Size: ____ Left ____ Right Occupation: (Check appropriate box) Spouse's Name: _________________________ 2nd Spouse's Name: ______________________ 3rd Spouse's Name: ______________________ Lover's Name: ___________________________ Relationship with spouse: (Check appropriate box) 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: Model and year of your pickup: 196_ Do you have a gun rack? Newspapers/magazines you subscribe to: 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: Color of eyes: Right_____ left_____ Color of hair: Color of teeth: How far is your home from a paved road?
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