| First Name: ________________________ Last Name: ________________________ Nicknames (if any): _______________________ E-Mail: _________________________ Gender (please circle): M / F Age: _____ Date of Birth: ________________ Marital Status / Significant Other: Single: . Widowed: . Married: . If so, how many times? _____ Divorced: . If so, how many times? _____ Boyfriend/Girlfriend: . If you have children, please list their names and ages (please list any step children too): What is your current occupation? What is your level of education and what school(s) did you attend? Name three of your favorite hobbies. 1. _______________________________________ 2. _______________________________________ 3. ______________________________________ Have you been treated for any serious physical or mental illness(es) within the last three years? YES / NO Is yes, please describe in detail, citing dates, diagnosis and any on-going problems: Please list any allergies you have (medications, food, hay fever, dust, etc.) and your current treatment for them: List three adjectives that best describe yourself: 1. ____________________________________ 2. ____________________________________ 3. ____________________________________ If you could hold any political office, what would it be and why? What is the accomplishment you are most proud of? Do you have pets? If so, please list their name and type: Are you a vegetarian or do you eat meat? |
| What is your favorite TV Show? What is your favorite movie? What is your favorite music to listen to? Have you seen a full season of Queer eye? Describe your perfect day: To which other reality shows or dating shows, if any, have you applied? Do you have any body art (piercing, tattoo, etc. )? If so, please describe: Who is your hero and why? List three (3) items you would take with you to the remote location, if allowed, and why. What would be the craziest, wildest thing you would do for a million dollars? What would you NOT do for a million dollars? What is your favorite topic of conversation at a dinner party? What topics are off limits? Have you ever been arrested or been the subject of any disciplinary charges of any kind? If so, what were the charge(s) and/or accusations and were you convicted or disciplined, and if so, in what way? What types of people would you choose to have with you on SURVIVOR? If you were stranded, who would you most want to be stranded with? What is your primary motivation for being gay? What is your secondary motivation for being gay? Please list three references: (signiture)_____________________ (Date) ____________________ Thank you for your time. You will be contacted with the acceptance or denial of your application. So be patient you priss. Your membership card will be sent to you in the mail. |
| Application for Homosexuality |