Jake's Probing Questionnaire!

Please realize that some answers will disqualify you, and others make no difference at all.

Questionnaire Filer #:
E-Mail Address:
How old are you:
Full Name:
City / State:
Your Country:
Home Phone Number:
Work Phone Number:
Fax Number:
Pager Number:

I'd like to know a little bit about you for my files:

Tell me, who are you? Describe yourself!
What do you hope to get by filling out this form?
When will you be in the San Francisco Bay Area?
Do you smoke cigars?
Do you light cigars?
Do you ride a motorcycle?
If so, how big is it?
Are you a techno-weenie, or a workaholic? (Select Multiple)
Are you a psycho, a chronic liar, a murderer? (Select Multiple)
What do you eat??
What do you regret?
How did you find this page?
Do you have any of these? (Select Multiple)

Please review what you have written before you :