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.