Full legal name__________________________________ Date___________________
Three major aliases ______________________,
______________________, ______________________
Nationality _________________________________________
Purpose of trip (attach
additional pages if needed)_______________________________________
Have you visited any hostile
national entities in the last three days? Yes No
Have you eaten any forbidden
fruits this year? Yes No
Do you own one or more cats? Yes No
Have you ever been injured by a
cat? Yes No
Do you have permission from your
dogs to enter Dogland? Yes No
Will your dogs be escorting you?
Yes No
Do you support the eradication
of autumn olive? Yes No
Do you own, or have you had any intimate physical contact
with, any of these in the last 3 weeks (circle any that
apply):
Llamas, reindeer, polar bears, mudpuppies, black rhinos,
Neanderthals, puffins, golden toads, Irish elk, quagga,
or ivory-billed woodpeckers? Yes No
Do you support the International Convention
for the Regulation of Whaling? Yes No
Have you seen any meteors in the last 10 days? Yes No
Have you seen Star
Wars: The Last Jedi? Yes No
Applicant’s signature
______________________ Approved, DL Secy. of State
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