Name:______________

Stage name:________________

Agent:______________  Attorney:__________________

Sex:  Male___   Female___   Formerly Male___   Formerly Female___

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 check activities you perform while driving: (Check all that apply)
   [  ] Eating
   [  ] Applying make-up
   [  ] Talking on the phone
   [  ] Slapping kids in the backseat
   [  ] Having sex
   [  ] Applying cellulite treatment to thighs
   [  ] Tanning
   [X] Snorting cocaine (already checked for ease of application)
   [  ] Watching TV
   [  ] Reading Variety
   [  ] 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 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: ___________________________________.

Length of daily commute:
   a) 1 hour
   b) 2 hours
   c) 3 hours
   d) 4 hours or more

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 the news on a high-speed chase
   c) Call your attorney and discuss lawsuit against cellular phone company for 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 instance 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 thus ensuring yourself of a hefty lawsuit

Please turn in your test to the lady behind the bullet-proof window on your left.