Professional Documents
Culture Documents
TM & Copyright 1983, 1987, 2005 by Eric Goldberg & Greg Costikyan. All Rights Reserved. Mongoose Publishing Ltd., Authorized User.
E-mail questions and comments to Mongoose Publishing at sales@mongoosepublishing.com, or write to PO Box 1018, Swindon, Wiltshire SN3 1DG, UNITED KINGDOM.
On the World Wide Web: www.mongoosepublishing.com. URL for this Form Pack: http://www.mongoosepublishing.com/downloads.php?qsSeries=19
Name __________________________-____-_______-____
Date and time ____________________________________
!
!
!
!
Happy
Unhappy
Enthusiastic
Cunning
!
!
!
!
Morose
Powerful
Kind of tingly
Apathetic
!
!
!
!
Satisfied
Very worried
Inferior
Despairing
!
!
!
!
!
I love mutants
! The Computer loves mutants
I am being blackmailed
! I dare not disobey
I lost a really dumb bet
! Honesty is the best policy
I have a death wish
! My head is going to explode
My awesome might should be used for the good of all Alpha
Complex
ID
______________
______________
______________
______________
______________
_____
_____
_____
_____
_____
ASSIGNMENTS
Registration Contact
Medication
Surveillance
Termination
______________________
______________________
______________________
______________________
!
!
!
!
!
Yes
Yes
Yes
Yes
Yes
!
!
!
!
!
No
No
No
No
No
I have been on the premises of a nuclear reactor within the last three months.
I have watched more than two complete episodes of the Best Good Happy Sector Hour.
I have heard of the secret society known as Psion.
If given the choice, I would opt to terminate myself in hopes that my next clone would not suffer from this mutation.
My mutation is powerful enough to possibly harm the citizens, social institutions and/or property of Alpha Complex.
If yes, why should you be permitted to live on as a menace to all who surround you?
If no, how will your mutation be of any use to Alpha Complex?
What can you possibly hope to accomplish that would make up for the mere fact of your blighted existence?
How long will it take you to do this?
Describe your mutation. Include specific examples with time, date, location and witnesses.
Please list all citizens you have damaged, injured or inconvenienced with your mutation. Continue on reverse if necessary.
Citizen
Date and Time
Location
Offense
__________________________
_____________________
_________________
___________________________
__________________________
_____________________
_________________
___________________________
__________________________
_____________________
_________________
___________________________
__________________________
_____________________
_________________
___________________________
__________________________
_____________________
_________________
___________________________
The average handling time for this form is between THREE DAYS and EIGHTEEN MONTHS. Resubmitting an identical copy of this form will not expedite processing in any way. If you need to alter or amend any information on this form, resubmit it with an attached Application Modification Rider (993-51-Z8854). Until this form has
been duly and fully processed, you are not authorized to use your purported mutation in any way whatsoever. If your application for Registered Mutant status is approved,
you will be retroactively subject to all requirements and regulations thereof, in accordance with section 72 of the Laws of Alpha Complex ed. 39/B.3.9.
Form 776-Z/0-T82
Name ________________________-____-_______-____
Location (current) _______________________________
Date and time (current) ___________________________
Height (current) _________________________________
Weight (current) _________________________________
Sanitation grade (current) _________________________
No. of mutants killed (career) ______________________
No. of mutants turned in (career)____________________
FOR AUTHORIZED USE ONLY
Additional notes
Loyalty index
Credibility index
Transition rating
! Yes
! Yes
! Yes
! No
! No
! No
_____________
_____________
_____________
ATTACHED DOCUMENTATION
Description
! _____________________________
! _____________________________
! _____________________________
! _____________________________
! _____________________________
! _____________________________
Reference code
_________________
_________________
_________________
_________________
_________________
_________________
Describe the suspicious activity in detail. Include the names of all citizens involved and/or present. Note any registered mutants.
! Yes
! No
SECTION 1: IDENTIFICATION
Name __________________________-____-______-____
Service firm _____________________________________
Housing unit ____________________________________
Registered Mutant Tracking Code ____________________
Date and time granted _____________________________
[DELETED FOR SECURITY REASONS] ______________
DNA Checksum __________________________________
!
!
!
!
!
!
!
!
!
!
Dosage
Frequency
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
Additional instructions:
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
!
!
!
!
!
!
!
!
!
!
!
!
!
!
No
No
No
No
No
No
No
No
No
No
No
No
No
No
ESSAY #1: What is the proper role of registered mutants in Alpha Complex? Please answer without using any of the following words:
Complex, Computer, do, dont, I, it, mutant, mutation, power, they, think, Troubleshooter, use and vat.
ESSAY #2: How has your life been affected by mutants, both registered and not?
Thank you for taking this Mandatory Survey. No follow-up on your part is required. If further information is necessary, Internal Security will contact you.
Form SS/712-993704