(Massachusetts residents need not apply)

1.  Do you consider yourself a member of any of the following
    minority groups?     (Check where applicable)

____Ku Klux Klan ____Sexaholics Anonymous ____Young Americans for Freedom ____The Boy Scouts ____Daughters of the American Revolution ____Larouche for President ____Moral Majority ____Flat Earth Society

2. Sex: ____Male ____Female ____Not Sure

3. Marital Status: ____Single ____Married ____Adulterer

4. Have you or any member of your immediate family ever been indicted on tax-evasion charges?

5. Have you ever been arrested and charged with any of the following?

-Having sex with a high-class call girl in an expensive hotel room -Having sex with a $20 prostitute in a cheap hotel room -Loitering outside a 7-Eleven shop -Punching a judge -Possession of kiddie porn

6. Are you allergic to polyester?

7. Does the Bible condone the hiring of private detectives to trail business associates? Explain.

8. When you pray to God, do you secrectly ask him to:

-Deliver you from your obsession with anal sex -Help you overcome your masturbation habit -Work up the courage to cruise the motel district outside of town

9. If necessary, can you shed tears in public without embarrassment?

10. If a gay, black, non-smoking, non-drinking, secular humanist, with a law degree, became president of the United States, would you stop believing in God? Explain?

11. If you needed to collect a million dollars in a hurry, which method would you choose?

-Lock yourself in a tower and warn everyone that God will strike you down if the money is not forthcoming -Blackmail a business associate -Buy an hour of time on Sunday morning television -Make friends with a dog track owner

12. If your had a few hundred thousand dollars left over, would you:

-Air condition your doghouse -Cruise the local motel district outside of town -Buy a house for your adulterous son-in-law -Open a theme park

13. How long did the minister hold you under water when you were baptised?

____60 seconds ____2 minutes ____10 minutes

14. Although most rock lyrics are the work of the Devil, do you ever find yourself humming Tammy Wynette's hit Country/Western single, "Heaven is Just a Sin Away?"

15. Which treatment would you choose if you were diagnosed with colon cancer?

-Enroll in the Mayo Clinic in Rochester, Minnesota -Ask the local revivalist to lay hands on you and hope for a miracle

16. If you were in a steam room with another naked man and he asked you for a back rub, how would you react? (Make sure to quote biblical chapter and verse.)

17. Write a brief essay on any two of the following well-known Fundamentalist catchphrases:

-"I plead guilty, your honor." -"I have sinned, my Lord, against you." -"On advise of counsel, I decline to answer that question under the provision of the Fifth Amendment." -"All I want to do is jack off while I look at you tits."

Signature:______________________________________________________ Date:___________________________________________________________

Send to: Jimmy Swaggert Ministeries P.O. Box 2550 Baton Rouge, LA 70821-2550