Slimez McGimez, Ltd.

SLUG CLUB APPLICATION

APPLICANT SLUG INFORMATION Name: Date of birth: Current address: City: Own Rent (Please circle) State: ZIP Code: SAN: Phone:

Previous address: City: Slug mail: SLUG EMPLOYMENT INFORMATION (OPTIONAL) Current employer: Employer address: Phone: City: Position: Previous employer: Address: Phone: City: Position: Address: City: Relationship: CO-APPLICANT SLUG INFORMATION, IF FOR A JOINT SLUG APPLICATION Name: Date of birth: Current address: City: Own Rent (Please circle) State: Monthly payment or rent: ZIP Code: How long? SAN: Phone: State: E-mail: State: Hourly Salary (Please circle) How long? Fax: ZIP Code: Annual income: Phone: ZIP Code: E-mail: State: Hourly Salary (Please circle) How long? Fax: ZIP Code: Annual income: State: ZIP Code:

Name of a relative not residing with you:

Previous address: City: Slug mail: SLUG EMPLOYMENT INFORMATION Current employer: Employer address: Phone: City: Position: Previous employer: Address: Phone: City: Position: E-mail: State: Hourly Salary (Please circle) Fax: ZIP Code: Annual income: E-mail: State: Hourly Salary (Please circle) How long? Fax: ZIP Code: Annual income: State: ZIP Code:

Slimez McGimez, Ltd.

SLUG CLUB APPLICATION

SLUG REFERNCES If you know a current member of the Slug Club, please fill out the following: Address: City: Relationship: SLUG ETHNICITY We do NOT discriminate against slugs of any background (unless you are in fact a snail). Circle all those which apply. If you are a gastropod, bivalve, or mollusk OTHER than a slug, or a snail who has become a slug, you may still submit an application; circle other and write a statement below explaining why you want to join the Slug Club. Keel Back Banana Round Back Ghost Leopard Sea Lusitanian Freshwater other HAVE YOU EVER BEEN CONVICTED OF A SLUG FELONY? IF SO, EXPLAIN. State: Phone: ZIP Code:

SLUG STATEMENT Why would you like to be a part of the Slug Club ?

I authorize Slimez McGimez, Ltd. to verify the information provided on this form as true by means of a thorough background check AND slime sample.

Signature of applicant slug

Date

Signature of co-applicant slug, if for joint application

Date