Application for Guest Apperance to the

Jerry Springer Pics taken from here...

First Name:_______________________ Last Name:____________________
Address:_________________________ City:_______________________
State:___ Zip:_________
Phone:(___)-___-____ Ex.______

Click all that apply....(Creativity Encouraged)

Sex
Male
Female
Both
Neither
Former Male
Former Female

Sexual Preference
Lesbian
Bi-Sexual
Gay
Straight
Animals
In-animate Objects

Physical Condition
Pregnant
Handicapped
Overweight

Employment
Stripper
Unemployed
Pron Star
Post Office Worker
Pimp
Others need not apply

Can you fight?
Yes
No

Reason for application?
I am a cheating Lesbian who's pregnant by my lovers father
I am involved in a three some with my gay lover and a chia pet.
I want to tell my lover a secret as if he doesn't know it's gonna be about me cheating on him/her.
I am extrememly fat.
Basically, I am white trash and I want to let the world know.
I have a deep, dark secret that I can only share in front of millions of people.
I have very intimate family problems that I want to let the world in on.
I want to get into a fight.
I am in the KKK.
I am a member of the Black Panther.
I am a member of an extremest group.

Due to the fact that our show is White Trash Telelvision at it's finest, this is all the information we need to know.

Please print out this from and send it to....

Jerry Springer Show
454 N. Columbus Drive
Second Floor
Chicago, IL 60611

 

 

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