Name: ______________ Stage name: ________________
Agent: ______________ Attorney: ________________

Sex: [ ] male [ ]formerly male [ ] both
[ ] female [ ] 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

[ ] Lawyer
[ ] Actor/Waiter
[ ] Film-maker/Self-employed
[ ] Writer
[ ] Car Dealer
[ ] Pan-handler
[ ] Agent
[ ] Hooker/Transvestite
[ ] Other; please explain: ______________

Please indicate how many times you expect to have sex in car:_______
Please indicate how much you plan to spend for this sex._________

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
Men: Please list shade of hairplugs. ___________

Please check activities you perform while driving:
(Check all that apply)
[ ] Eating a wrap
[ ] Applying make-up
[ ] Talking on the phone
[ ] Having sex
[ ] Applying cellulite treatment to thighs
[ ] Tanning
[ ] Snorting cocaine
[ ] Watching TV
[ ] Reading Variety
[ ] Surfing the net via laptop

Please indicate how many times you:
a) expect to shoot at other drivers ________
b) expect to be shot at while driving________

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 resident).

Please indicate if you drive:
a) a Beemer,
b) a Lexus,
c) a Mercedes,
d) Cabriolet. If your answer is D, please add six to eight weeks to normal delivery time for your driver's license.

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

Please indicate number of therapy sessions per week: ____.

Are you presently taking any of the following medications?
a) Prozac;
b) Zovirax;
c) Lithium;
d) Zantax.
e) If none, please explain: __________________.

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

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 multi-million dollar lawsuit, book, radio and tv contracts.

Webmaster@Robin's Web
with questions or comments regarding this site.
Graphics on this page are original and
copyright© protected-1997. Robin L. Olson, Robin's Web,

All Rights Reserved.