How do you see yourself joining the family? Marriage Adoption Either

First Name: Last Name:

Occupation:

Gender: Male Female Mixed/Other

Marital Status: Single Married Divorced Involved

In what year were you born?

Email Address:

Phone Number:

Briefly (five hundred characters or less, any more are discarded) decscribe yourself in each of the ways labeled below. Select the radio button next to the label you think is most imprtant to you.

Physically:

Spiritually:

Intellectually:

Morally:

Where do you live? Unfortunately we are currently taking applicants from the US only.

Street: State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C West Virginia Wisconsin Wyoming Zip:

Do you live alone? Yes. No.

Are you willing to relocate? Yes. No.

Why do you want to be a Roe (in twenty characters or less)?

Which of the following do you prefer?

Books Movies Theater Musical Theater Television Sports

What is your favorite work?

Do you like art? Yes. No.

Who is your favorite artist?

Do you like music? Yes. No.

Who is your favorite musician?

Do you read? Yes. No.

Who is your favorite writer?

What is your favorite sports team (none if none)?

How do you best express yourself (in twenty characters or less)?

Any hobbies or passions (in forty characters or less)?

Any phobias (in forty characters or less)?

Are you in debt? Yes. No.

Are you fit? Yes. No.

Have you ever been arrested? Yes. No.

Have you ever participated in a family before (Manson does not count as a family)? Yes. No.

How would you describe your orientation: Heterosexual Homosexual Either Nonsexual Other

Do you drive? Yes. No.

Are you:

Agnostic Atheistic Ayyavazhi Born Again Buddhist Catholic

Confucianist Christian (Orthodox) Christian (Other) Christian Scientist Deist Hari Krishna

Heaven's Gateist Hindu Jainist Jehovah's Witness

Jewish (Conservative) Jewish (Kabbalah) Jewish (Orthodox) Jewish (Reform) Moonie

Mormon Mormon (Fundamentalist) Muslim (Kharjite) Muslim (Shi`ite) Muslim (Sufi) Muslim (Sunni)

Raelean Scientologist Shintoist Snake Handler Taoist Unitarian Unlisted Wiccan

Are you:

Have you ever held public office? Yes. No.

Have you ever served in the military? Yes. No.

Are you chronically ill? Yes. No.

Are you dangerous? Yes. No.

Are you honest? Yes. No.

Are you happy? Yes. No.

Do you know any Roes? Name up to three:

1. 2. 3.

How did you find this site?

Friend Enemy Spam TMZ Graffiti N.Y. Times

Mad Magazine Vanity Fair Referential Mania Primary Care Physician Insomnia