Like, 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:
