AMERICAN PATRIOT REGISTRATION
Name in Full:
E-mail Address:
Date of Birth: Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
Country of Origin: ... United States of America Other (Militant Muslim Theocracy) Other (Non-Militant Muslim Theocracy)
Marital Status: ... Single Married Homosexual
Political Affiliation: ... Republican (Right-Wing) Republican (Conservative) Republican (Moderate) Other/Communist
Religion: ... Methodist Baptist Catholic Branch Davidian Jew for Jesus Jew against Jesus Other (Militant Fundamentalist) Other (Non-Militant Fundamentalist)
Have you ever been convicted of a crime? ... Yes Not Yet
If YES, please indicate crime: ... Loitering Littering Shoplifting Drug Dealing Sodomy Hijacking Chemical Weapons Production Biological Weapons Production Nuclear Weapons Production Mass Murder Maniacal Fits of Public Laughter
I love America. ... True False
The best way to fight terrorism is to visit Disney World. ... True False
I am a terrorist. ... True False
I am sure. ... True False
Toenail clippers are potential instruments of murder. ... True False
White people are almost never crazy. ... True False
Vegetarians are traitors to the American way of life. ... True False
Indefinite detentions of minority groups are a privilege of citizenship. ... True False
Fox News is fair, balanced, and profoundly watchable. ... True True
Black people wearing those "big pants" are suspicious. ... True False
Rush Limbaugh is an elected official. ... True False
He should be. ... True False
Even though he was kind of a cripple for awhile. ... True False
People who wear turbans are, more often than not, mad dog killers. ... True False
My favorite movie is: ... Rambo Red Dawn Top Gun The Cunt for Red Cocktober Die Capitalist Pig II: Uncle BAM!
On Sunday afternoons, I like to... ... Watch football Drink beer Watch football and drink beer Case nuclear power plants
Asians are particularly good at math. ... True False
My favorite food is: ... Apple pie Cheeseburgers Hot dogs PB&J Goat eyeball cous cous
The TRUE capital of the United States is: ... Crawford, TX Houston, TX Dallas, TX Austin, TX Graceland New Jalalabad, CT
What Would Jesus Do? ... Walk on water Gun down abortion doctors Cure the blind Give $300 Tax Rebates Kick Mohammed’s ass Jesus who?
On a scale of 1 to 10, what is Pamela Anderson? ... 10 5 1 Godless whore
George W. Bush is: ... My kind of guy A real stand-up guy A guy’s guy The guy next door The Great Satan Infidel!
Which is the least important right? ... Speech Assembly Representation Guns Religion "Due Process" Cultural hegemony
Criticism of the Government: ... Aids and abets terrorists Is the mark of a traitor terrorist Is perpetrated by people brainwashed by terrorists Is probably the result of LSD in the drinking water All of the above Will help topple the Great Satan infidels!
Democracy is based on what principle? ... Country clubs rule Stockholders rule Moral hypocrites rule Republicans rule Majority rules Flaming Sword of God rules
US Foreign Policy: ... Is totally fair and NOT based on the financial interests of Big Oil! Kicks proverbial ass Who cares? PERPETUATES ZIONIST EVIL!
Finally, in 25 words or less, complete the sentence, "I deserve my American citizenship because..."NOTE: The response "Because I was born here" (or any variation thereof) will NOT be accepted.
By submitting this questionnaire, I hereby relinquish my right to habeas corpus and all other supposed rights afforded me by the Bill Of Rights. If I am a citizen of the United States and I submit this form, I acknowledge that the Department of Justice and/or the FBI may use this information to arrive at the conclusion that I am some kind of pinko, commie, freedom-hating towel-headed homo who deserves to get a steel-tipped federal jackboot shoved up my treacherous ass, so help me John Ashcroft.
*The Department of Justice would like to thank Jolene Cornsilk of Keota, OK for this inspired suggestion. 
Now this IS scary!
