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  Name: _______________ Stage name: ________________
  Agent: ______________ Attorney: __________________
  Sex: ___male ___female ___formerly male ___formerly

  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
  [ ] Having sex
  [ ] 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

  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

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