JUSTINTERACTIVEFORM – JUSTIN RUPPLE

DATE

FIRST NAME *

PICK YOUR SCREEN NAME FOR THE SHOW

AGE *

GENDER *

I LIVE IN (TOWN/CITY) *

HIGH SCHOOL/COLLEGE NICKNAME *

EMAIL *

PICK A FAVORITE CELEBRITY FROM THE IMAGES ABOVE

PICK A CHARACTER FROM THE IMAGES ABOVE

PICK A SINGER FROM THE IMAGES ABOVE…

____________ DESCRIBES THE PLOT OF FAVORITE MOVIES. *

MY WORST CELEBRITY DINNER GUEST IS… *

I HAVE A TATOO OF ________

ON MY _________

NICKNAME FOR SIGNIFICANT OTHER *

GIVE US THE NAME OF THE NEXT SUMMER BLOCKBUSTER MOVIE…

STARRING… *

AND THIS CELEBRITY *

CHOOSE THE NEW SLOGAN FOR BELLEVUE

I _______ IN THE CAR WHEN NO ONE’S LOOKING

ASK ANY QUESTION YOU WOULD LIKE, THIS IS AN OPEN AND ANOMYMOUS QUESTION