Want to be on jerry springer ?!


Question: Personal Information:
Name________ _Nickname_ ________CB Handle______ _
Yore Mama________ __ Yore Daddy (if known)______ __
Spouse's Name________ _________
Relationship to spouse: __Sister
__Brother__Mother_ _Father
__Aunt __Uncle ___ Pet___Several of the above
Occupation: ___Unemployed Mechanic ___Gun Show Dealer
___Skinhead_ ___ Full Time Thinker
Number of Children in Household___ Number that are
yours___
Circle Highest Level of Education: 1 2 3 4 How many
times each
grade How Far is Your Mobile Home From a Paved Road:
___1mi. __5 mi. ___?
Number of Times You Have Survived a Tornado: ___
Number of Vehicles Owned___ Number on Cement Blocks
___ Number____ Repossessed_ __
Truck Equipment: ___Gun Rack ___Spit Cup ___Fuzzy Dice
___Rebel Flag___Naked Woman Mudflaps ___NRA sticker
Weapons Owned: ___Tire Iron ___Pick Handle ___Beer
Bottle
___Shotgun
Number of Dogs Owned: ___
Number of Homemade Tattoos:___
Which of the Following Appliances are in your Front
Yard:
___Friggerator ___Heatin Stove ___Warsher ___TV
___Freezer
How Many of the Above Appliances Work: ___
Fav-o-rite Recreation: ___Drinkin ___Cow Chip Throwin
___Possum Huntin___Crawdad Huntin ___Scratchin
___Watchin Wrasslin
If You Can Read, Which Magazines Do You Prefer:
___Soap Opera Digest ___NWA ___Rifle and Shotgun
___TV Guide __National Enquirer ___True Confessions
Which Stinks Worse: ___Hogpen ___Outhouse ___Spouse
Can You Spell Your Last Name:___Yup ___Nope
Can You Remember Your Last Name: ___Yup ___Nope
Have You Ever Stayed Sober for More Than One Day:
___Yup
___Nope
Do You Know Any Words with More Than 4 Letters: ___Yup
___Nope
Which is Correct: ___"I Seed Him" or ___"I Seen Him"
How Many Cartons of Cigarettes Do You Smoke a Day? ___
Math Test: How Many Food Stamps Do the Following Cost?
___Six Pack ___Cigs ___Shotgun Shells ___Whore
Number of Times You've Seen: ___a UFO ___ Elvis
___Elvis in a UFO
Health Questionnaire: Which of the Following Do You
Have?
___Head Lice ___B.O. ___Crabs ___Runny Nose___Boils
Can You Remember the Last Time You Bathed? ___Yup
___Nope
Color of Teeth: ___Yellow ___Brown ___Black ___N/A
I hereby swear this is the trooth and sign my "X


Answers: Personal Information:
Name________ _Nickname_ ________CB Handle______ _
Yore Mama________ __ Yore Daddy (if known)______ __
Spouse's Name________ _________
Relationship to spouse: __Sister
__Brother__Mother_ _Father
__Aunt __Uncle ___ Pet___Several of the above
Occupation: ___Unemployed Mechanic ___Gun Show Dealer
___Skinhead_ ___ Full Time Thinker
Number of Children in Household___ Number that are
yours___
Circle Highest Level of Education: 1 2 3 4 How many
times each
grade How Far is Your Mobile Home From a Paved Road:
___1mi. __5 mi. ___?
Number of Times You Have Survived a Tornado: ___
Number of Vehicles Owned___ Number on Cement Blocks
___ Number____ Repossessed_ __
Truck Equipment: ___Gun Rack ___Spit Cup ___Fuzzy Dice
___Rebel Flag___Naked Woman Mudflaps ___NRA sticker
Weapons Owned: ___Tire Iron ___Pick Handle ___Beer
Bottle
___Shotgun
Number of Dogs Owned: ___
Number of Homemade Tattoos:___
Which of the Following Appliances are in your Front
Yard:
___Friggerator ___Heatin Stove ___Warsher ___TV
___Freezer
How Many of the Above Appliances Work: ___
Fav-o-rite Recreation: ___Drinkin ___Cow Chip Throwin
___Possum Huntin___Crawdad Huntin ___Scratchin
___Watchin Wrasslin
If You Can Read, Which Magazines Do You Prefer:
___Soap Opera Digest ___NWA ___Rifle and Shotgun
___TV Guide __National Enquirer ___True Confessions
Which Stinks Worse: ___Hogpen ___Outhouse ___Spouse
Can You Spell Your Last Name:___Yup ___Nope
Can You Remember Your Last Name: ___Yup ___Nope
Have You Ever Stayed Sober for More Than One Day:
___Yup
___Nope
Do You Know Any Words with More Than 4 Letters: ___Yup
___Nope
Which is Correct: ___"I Seed Him" or ___"I Seen Him"
How Many Cartons of Cigarettes Do You Smoke a Day? ___
Math Test: How Many Food Stamps Do the Following Cost?
___Six Pack ___Cigs ___Shotgun Shells ___Whore
Number of Times You've Seen: ___a UFO ___ Elvis
___Elvis in a UFO
Health Questionnaire: Which of the Following Do You
Have?
___Head Lice ___B.O. ___Crabs ___Runny Nose___Boils
Can You Remember the Last Time You Bathed? ___Yup
___Nope
Color of Teeth: ___Yellow ___Brown ___Black ___N/A
I hereby swear this is the trooth and sign my "X

You've been verrrrry busy.
Hope you didn't break a nail.
You probably have bug eyes by now, lol.
This is a whole bunch of jokes.
Ha ha ha ha.....
?????

wow, you have too much time on your hands if you typed all that out for no reason at all.

Thats great, I think it sums the show up nicely and it gave me a good laugh as well thanks.

like it

That just about sums up EVERY talk show, not just springer


You must have a lot of time on your hands, to type all that out.

hahahahahahaaaa =D this formm is for waste people...really creative if u made it upp 8-)

thats very good thanks

wow ,,, cool ,,, yea ,,, nah ,,, aliens ,,,, Mr Harry Potter,,, Miss Piggy ,,, thousands ,,,, squash ,,, tooth fairy ,,,



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