NAME

CONTACT EMAIL


HEIGHT

HAVE YOU EXPERIENCED ANY KIND OF INVOLUNTARY BODILY MOVEMENT (Y/N)

IF YES, PLEASE SPECIFY

ARE YOU SATISFIED WITH THE PRECISION OF YOUR BODILY MOVEMENTS

DO YOU HAVE ANY OTHER RELEVANT SYMPTOMS

IS THERE ANYTHING WORTH DYING FOR

NO, NOTHING
FRIENDS
FAMILY

LIST PRECAUTIONS OR WARNINGS ABOUT YOURSELF

DESIRED PROGRAM DURATION (MAX 7 HOURS)

TIME AND DATE OF YOUR PROGRAM

SIGNATURE, DATE*

*NOTE: GESTURE GUILD IS AN INSTITUTION OF DARKEST CONFIDENCE
DO NOT SIGN THIS FORM IF YOU CANNOT HONOR THIS BINDING OATH