1. Place your Photo here.
2. Name
   Date of birth
   Address
   Phone Number
   Social Security Number
   Boy Scout rank
   Mother's name
   Father's name
3. Do you own any of these items:
• motorcycle
• muscle car or sports car
• earring
• van
• firearm
• tattoo
• truck with oversized tires
• exotic pet, such as a snake
• electric guitar

[If you checked any of these items, discontinue application and leave immediately.]

4. Do you:
• Do you smoke? Yes No
• Do you drink? Yes No
• Do you gamble? Yes No
• Have you ever been arrested? Yes No
• Do you ever drive over the speed limit? Yes No
• Have you ever seen Elvis? Yes No
• Have you ever seen a UFO? Yes No
• Have you ever seen Elvis in a UFO? Yes No

[If you answered Yes to any of the preceeding questions, discontinue application and leave immediately.]

5. Preferred dating activity:
• Walk in the park
• Watch a School play
• Minature Golf
6. In 50 words or less, tell exactly what the words "Don't be late" mean to you.
7. You must attach a complete police record and latest diploma or transcript.
8. Signatures
• Your Signature
• Parents' signatures
• Police Chief's signature

[Please allow 4 to 6 years for processing. Any unanswered questions will result in forfeiture of application. Apply at your own risk.]