Name: _____________________________________________________________________
(extra space left due to new social awareness)- Ethnic Information: (voluntary)
- ____ Eskimo
- ____ American Indian
- ____ Hispanic
- ____ Asian
- ____ African-American
- ____ American-African
- ____ Black-American
- ____ Other Group With A Long History Of Oppression By White Males
(specify, so we can help you form a political action group)
___________________________________________________- Type of Cars Owned (pick two):
- ____ SAAB
- ____ Volvo
- ____ BMW
- ____ Mercedes
- ____ Honda
- You don't own any *American* cars, do you?
- ____ NO
- Car Equipment:
- ____ Blaupunkt
- ____ Passport
- ____ Escort
- ____ Vuarnet Sunglasses
- ____ Stash
- ____ CD
- ____ Cellular Phone
- ____ Ski Rack
- ____ Bicycle Rack
- ____ Wine Rack
- Bumper Stickers:
- ____ "You can't hug a child with nuclear arms"
- ____ "Greenpeace"
- ____ "Dukakis/Bentsen"
- ____ "Save the Whales"
- ____ "Farms not Arms"
- Sexual Orientation:
- ____ Gay
- ____ Lesbian
- ____ Other
(note: failure to give the proper answer to the above means you can't live in certain towns on the Cape, or get elected to Congress)
- Favorite Cause:
- ____ Whales
- ____ Baby Seals
- ____ Snail Darter
- Total given to these causes in the last 12 months: ________________
- Favorite Drugs:
- ____ Crack
- ____ Coke
- ____ Grass
- ____ Kitty's Diet Plan
- Which of the Following Should be Banned? (check all that apply)
- ____ The Bomb
- ____ Handguns
- ____ All guns
- ____ Nuclear Power
- ____ Cigarettes
- ____ The NRA
- ____ Republicans
- Which of the Following Should be Legalized?: (check all that apply)
- ____ Crack
- ____ Coke
- ____ Grass
- ____ Needles
- ____ Flag Burning
- Favorite Beer:
- ____ Samuel Adams
- ____ Beck's
- ____ Corona (w/lime)
- ____ Latest trendy brand
- Favorite Politician:
- ____ Ted Kennedy
- ____ John Kennedy
- ____ Bobby Kennedy
- ____ Joe Kennedy
- Club Memberships:
- ____ ACLU
- ____ Greenpeace
- ____ SDS
- ____ N.O.W.
- ____ A.F.S.C.M.E.
- ____ Billy Bulger Breakfast Club
- ____ Provincetown Boys Club
- ____ Bull-Dykes Kennel Club
- Even though we can't ever get any more power from Hydro-Quebec, don't you think that Seabrook should remain closed forever?
- ____ YES
- Don't you think that the people in the Midwest should stop dropping acid rain on our vacation homes in Vermont, even if it means that they all lose their jobs?
- ____ YES
- How many watts (per channel, RMS) is your principal home stereo?
- ____ 100W
- ____ 200W
- ____ More than that
- How many air conditioners do you have to help you through our long New England summers?:
- ____ 2
- ____ 3
- ____ 4
- ____ Central Air
(note: Fewer than two A/C units may qualify you for state subsidies if you are a non-white unemployed Democrat)
- Favorite TV Show:
- ____ Once and Again
- ____ Providence