GREATER LOS ANGELES AREA DRIVER'S LICENSE APPLICATION:

Name: ___________________________

Stage name: __________________________

Agent's Name: __________________________

Attorney's Name: _______________________

Sex:

[ ] male [ ] female [ ] formerly male [ ] formerly female [ ] both [ ] neither

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 [ ]

Actual Age: _____ Admitted Age: _____

Actual Height: _____ Admitted Height: _____

Actual Weight: _____ Admitted Weight: _____

Eyecolor: _____

Do you wear contact lenses? [ ] Yes [ ] No

Contact Lense Color(s)/Design(s): _______________

Please check hair color:

Females:

[ ] Blonde [ ] Platinum Blonde [ ] Dark Cherry Red

Teenagers:

[ ] Purple [ ] Blue [ ] Skin-head [ ] WhiteTip

Men:

Please list shade of hair plugs ________________

Occupation:

[ ] Lawyer

[ ] Actor/Waiter

[ ] Film-maker/Self-employed

[ ] Writer

[ ] Agent

[ ] Car Dealer

[ ] Cell phone Dealer

[ ] Drug Dealer

[ ] Pan-handler

[ ] Gang Member

[ ] Hooker/Transvestite

[ ] Dog Caregiver

[ ] Other; please explain:

___________________________

Medical Conditions: (check all that apply)

[ ] Eating Disorder

[ ] Psychotic Disorder

[ ] Schizophrenia

[ ] Drug Addiction

[ ] Others: ________________________________

Please check activities you perform while driving (Check all that apply):

[ ] sipping latte

[ ] eating a wrap

[ ] applying make-up

[ ] talking on the phone

[ ] rehearsing lines

[ ] slapping kids in the back seat

[ ] applying cellulite treatment to thighs

[ ] tanning

[X] snorting cocaine (already checked for ease of application)

[ ] watching TV

[ ] reading Variety

[ ] surfing the net via laptop

[ ] reading a book or newspaper

Please list brand of cell phone:

___________________________

(If you don't own a cell phone, please explain.)

___________________________

___________________________

___________________________

___________________________

Please indicate if you have Automobile Insurance:

[ ] Yes [ ] No

If Yes, please explain:
___________________________
___________________________
___________________________
___________________________

Please indicate how many times:
a) you expect to shoot at other drivers _____
b) and how many times you 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

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