Male Female Formerly Male Formerly Female Both 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 Actor/Waiter Actor/Waiter/Model Film-maker/Self-employed Consulting/Unemployed Writer/Waiter Car Dealer Pan-handler Agent Transvestite Other; please explain:
Brand of cell phone:
If you don't own a cell phone, please explain:
Females: Blonde Platinum Blonde Teenagers: Purple Blue Skinhead Men: Please list shade of hair plugs:
(Check all that apply)
Drinking a non-fat half cafe latte with a shot of vanilla and twist of lemon Applying make-up Talking on the phone Applying cellulite treatment to thighs Tanning Snorting cocaine Watching TV Reading Variety Surfing the net via laptop
Call the police to report the crime Call Channel 4 News to report the crime, then watch your car on the news on a high-speed chase Call your attorney and discuss lawsuit against cellular phone company for 911 call not going through Call your therapist All of the above
Beamer Porsche Mercedes Other If other, please explain:
stop your car. keep driving and hope for the best. immediately use your cell phone to call all loved ones. pull out your video camera and obtain footage for Channel 4.
never drive over 5 MPH. drive twice as fast as usual. you're not sure what "rain" is.
Prozac Zovirax Lithium Zantax If none, please explain:
1 hour 2 hours 3 hours 4 hours or more
pull over and have your driver's license and insurance form ready. try to outrun them by driving the wrong way on the 405. have your video camera ready and provoke them to attack, thus ensuring yourself of a hefty lawsuit.