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)