Name:
E-mail Address:
Street Address (Line 1):
Street Address (Line 2):
City:
State or Province:
ZIP or Postal Code:
Phone Number:
Birthday:
Birthplace:
Mother's Maiden Name:
Blood Type:	(Choose One) O Positive A Positive B Positive O Negative A Negative AB Positive B Negative AB Negative
Weight:
Height:
Allergies:
Gender:	Male: Female:
Current Net Worth:
Most Painful Childhood Memory:
Number of Bones You Have Broken:	(Choose One) None 1-3 4-6 More Than 7
Phobias:
Favorite '80s TV Show:
Least Favorite Ice Cream Flavor:
Tattoo:
Are You a Tattletale?	Yes: