I
<NAME>
VOUCHSAFE THAT I
HAVE
HAVE NOT DRUNK
TANKARDS OF IMPROVED FORMULA BEFORE COMPLETING THIS FORM
I NO LONGER EAT
<FAVOURITE FOOD>
YES
NO
I AM MAINTAINING A DIET THAT CONTAINS ONLY THE FOODS SPECIFIED ON THIS SITE
YES
NO
I HAVE EATEN A POTATO-BASED FOOD WITHIN THE LAST 72 HOURS
YES
NO
I DRINK TEA
YES
NO
I RENOUNCE GREEN AS A COLOUR FOR CLOTHES OR BED LINEN
YES
NO
CAROLINE HAS CHANGED SINCE DAVID CAME HOME
YES
NO
I
AM HAPPY
AM UNCOMFORTABLE
DON"T CARE ABOUT MY WEIGHT
I WOULD LIKE TO BE
TALLER
SHORTER
I WOULD LIKE TO BE
STRONGER
MORE INTELLIGENT
RICHER
MORE POTENT
I
WOULD
WOULD NOT BE HAPPY TO BE SENT ITEMS THROUGH THE POST RELATED TO DIETARY CONDITIONING
<ADDRESS IF KNOWN>
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