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 A Totally California State Residency ApplicationLike, A Totally California State Residency Application...    man...    Name:    (Feel free to use popular nicknames, such as "Moon Beam", "Dweezil",    "Moon Unit" "Capt. Trips", etc.)    Age: _____________    Inner Child's Age: _______    Age in Dog Years: _______    Age as told to you in a vision by ancient Mayan calendar: ________    Sex:    _____ M   _____ F    _____ Hermaphrodite    _____ Still working it out in therapy    Footwear: ____ Birkenstocks ____ Barefoot    Condition of Feet:    ____ Wash Daily   ____ Wash Weekly    ____ Like, whenever I get to    the beach, man...    Occupation:    ___ Massage Therapist    ___ Astral Counsel    ___ Pet Psychologist    ___ Channeler of the Dead (real dead, not    merely Grateful)    ___ Follower of the Dead, (Grateful)    ___ Tie-dye vendor at Dead Shows    ___ Vendor of "nice hot, fresh veggie    burritos" at concerts    ___ Cooking up a scheme to channel Jerry    Garcia    ___ Assistant to Shirley MacLaine    ___ Rent-A-Mob protester    ___ Purveyor of Fine Herbal Remedies    ___ Panhandler claiming to be a veteran    ___ Professional Guest on Ricki Lake    ___ LA rock star groupie    ___ Bottom-feeding LA lawyer    ___ Professional Emotional Victim    Name(s) of Significant Other(s): ________________________________    Relationship(s) of Significant Other(s):    ____ Astral Soulmate    ____ One-night stand from the protest rally who stayed because the    rent    was cheap    ____ My dog's massage therapist    ____ "Just Friends"    ____ They're really not that significant, but I'll try to claim them    as    tax deduction(s)    Number of Children in Commune: _____    Number of Inner Children In Commune: _____    Number of your Inner Children which have been molested by one of    Roseanne's multiple personalities: ____    Mother's Name: ____________________   Father's Name: ____________________    Where were you were conceived:    ____ Woodstock       ____ Monterey    ____ Under the stars on in the commune's    hot tub    ____ In the back of a VW micro-bus on the    way to a Dead show    Name of book exposing your parents as inner-child abusers:    Number of copies sold: ____    Number of Wind Chimes Owned: ____    Number of times you've given yourself a concussion by hitting head on    wind chimes: ___    Number of time you've channeled dead space aliens: ____    Number of times a space alien has copped a feel off you: ____    Talk Shows on Which You Make a Regular Appearance:    ____ Donahue   ____ Ricki Lake   ____ Geraldo   ____ Sally Jesse    ____ The morning news' surf report    Number of times you've eaten your surfboard: ____    Above, while still in parking lot after tripping on your sandals: ____    Number of Grateful Dead concerts attended: ____ (if all, enter "on    tour")    Number of bongs you own: ____    Number of times you've drunk your bong water because the weed ran out:    Political Party Affiliation: (Choose as many as you have    personalities)    ____ Green Party    ____ American Communist    Party    ____ Socialist Party    ____ New Age Astral Party (channeling the spirits of dead Romans)    ____ Hemp Party    ____ The Party-Hearty Party ____ Inner Child Abuse    Hotline Party    ____ New Age Goddess Party    How far is your home from the waterline:    ___ Miles    ___ Yards    ___ Feet    ___ I like to wake up with sand in my nose and seaweed in my teeth, in    true harmony with nature as it washes up my nose    Number of surfboards owned: ____    Number of seconds you can talk without using the words "totally",    "like", "man" and "fer shure": ____ (enter, like 0, if you, like,    totally don't know)
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