Henceforth and herein... A Voluntary Earthform Survey for Zeta Reticuli.
You know, Humor, mind control, extra-terrestrial,
alien contact, government conspiracy survey, survey,
a dogmatic thermometer as it twer.




Voluntary Earthform Survey
for Zeta Reticuli

the following information is requested by the life-forms
commonly known as the zeta riticuli
They are currently working on a project and could use your input.
Complete as much as you can and send it in. I'll relay the results


Are you currently receiving genetic impulses?
yes
no
maybe


If not would you like to be?
yes
no
maybe


Have you ever noticed any subtle hypnotic suggestions
pushing the desire to drop money on dinky crap at Walmart?
yes
no
maybe


For those with implants.
Are you experiencing any chaffing or dry skin?
yes
no
maybe


Which side of the brain are you most comfortable using (if any).
left
right


this is purely a hypothetical question
If you were to be brainwashed, which personality would you prefer we install ...
Rush Limbaugh
Barney
pentagon worker


Do you own a television?

yes
no


When would be the best time to catch you in deep sleep ...(again, hypothetically).


morning
afternoon
evening


How do you react to a sudden lose of blood?

get dizzy/passout
feel okay


Do you own a microwave?

yes
no



Please complete the following ...


legal name:   Hat size:

enter email here to subscribe to our galactic newsletter



If you were going to surprise yourself at night how would you get in your bedroom
without you knowing it?


Press this button to complete survey



the Zeta Riticuli thank you in advance for your false conception of time



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