$__________ Brand of cell phone: _______________________ (Note: If you don't own a cell phone, please explain how you manage to live.) Please indicate your current hair color: Females: [ ] Blonde: [ ] Platinum Blonde: Teenagers: [ ] Purple: [ ] Fluorescent green: [ ] None (Skinhead): Men: Please state shade of hairplugs: ____________________ Activities you regularly perform while driving (Check all boxes that apply): [ ] Eating a wrap [ ] Applying make-up [ ] Talking on the phone to your agent and/or dealer [ ] Slapping kids in the backseat [ ] Having sex [ ] Applying cellulite treatment to thighs [ ] Tanning [ ] Snorting cocaine [ ] Watching TV [ ] Reading Variety [ ] Surfing the net via a laptop Please indicate annualised average figures for the following: (a) The number of times you expect to shoot at other drivers: ____ (b) The number of times you expect to be shot at while driving: ___ (c) for (b) above, how many of these are self-inflicted: ____ Be aware that, if you are the victim of a car-jacking, you should immediately: (1) Call the police to report the crime. (2) Call Channel 4 News to report the crime, then watch your car in a high-speed chase on the news. (3) Contact your attorney and discuss lawsuit against cellular phone company for 911 call not going through. (4) Call your therapist. Note: None of the above apply if you are a South Central resident. Please indicate if you drive: [ ] A Beamer [ ] A Lexus [ ] A Mercedes [ ] A Cabriolet. Note: Cabriolet drivers please add six to eight weeks to normal delivery time for your driver's license. In the event of an earthquake, be ready to do one or more of the following: (a) Stop your car. (b) Keep driving and hope for the best. (c) Immediately use your cell phone to call all your loved ones. (d) Pull out your video camera and obtain footage for Channel 4. In the event of rain, do you (Check one box only): [ ] Never drive over 5 MPH [ ] Have to drive twice as fast as usual, because everyone else is going so slow! [ ] Require an explanation of the meaning of "rain". Please indicate number of therapy sessions per week: ______ Please indicate shortest journey for which you routinely use your vehicle: [ ] Only for distances greater than one mile, or [ ] Only for distances greater than one block, or [ ] Even for trips to the end of your drive to clear your mailbox. Are you presently taking any of the following medications? (Check all boxes that apply): [ ] Prozac [ ] Zovirax [ ] Lithium [ ] Zanax [ ] Viagra Note: If none of the above, are you quite sure you're in California? Length of daily commute: [ ] 1 hour [ ] 2 hours [ ] 3 hours [ ] 4 hours or more. When stopped by police, do you (Check all boxes that apply): [ ] 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.