this.document.write(' 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: Number of copies sold: ____ Number of Wind Chimes Owned: ____ Number of times you\'ve given yourself a concussion by hitting head on wind chimes: ___ Number of time you\'ve channeled dead space aliens: ____ Number of times a space alien has copped a feel off you: ____ Talk Shows on Which You Make a Regular Appearance: ____ Donahue ____ Ricki Lake ____ Geraldo ____ Sally Jesse ____ The morning news\' surf report Number of times you\'ve eaten your surfboard: ____ Above, while still in parking lot after tripping on your sandals: ____ Number of Grateful Dead concerts attended: ____ (if all, enter "on tour") Number of bongs you own: ____ Number of times you\'ve drunk your bong water because the weed ran out: Political Party Affiliation: (Choose as many as you have personalities) ____ Green Party ____ American Communist Party ____ Socialist Party ____ New Age Astral Party (channeling the spirits of dead Romans) ____ Hemp Party ____ The Party-Hearty Party ____ Inner Child Abuse Hotline Party ____ New Age Goddess Party How far is your home from the waterline: ___ Miles ___ Yards ___ Feet ___ I like to wake up with sand in my nose and seaweed in my teeth, in true harmony with nature as it washes up my nose Number of surfboards owned: ____ Number of seconds you can talk without using the words "totally", "like", "man" and "fer shure": ____ (enter, like 0, if you, like, totally don\'t know)');