mission

Thank you for the commitment to being part of Larry's Witnesses and wanting to 'Burn The Word'. Please complete the Mission Request Form below; once completed a Larry's Witnesses representative will contact you to finalize your mission submission within 3-5 Business Days. After you complete the Mission Request, you will be directed to a Confirmation page. This page will contain important Mission information, including your Mission Number. You should print this page for your records. If you have any questions or wish to check the status of your Mission Request, you will need this Mission Number. We will keep you informed via e-mail as your Mission Request is processed.


Note: For faster service call the Larry's Witnesses Hotline - 602.332.9825
     
Name: *  
Email Address: *  
Phone:  
Address: *  
City: *  
State: *  
Zip Code: *  

What Years Have You Attended Burning Man?
 
  1986 1990 1994 1998 2002 2006
1987 1991 1995 1999 2003 2007
1988 1992 1996 2000 2004 2008
1989 1993 1997 2001 2005 2009
2010 2011 VIRGIN!    
 
What days are you available to 'Spread The Word'? (6-Hour Shifts)
 
Monday Tuesday Wednesday Thursday
Friday Saturday Sunday Monday
 
 
Current Medical Conditions/Issues:
  Nervous Tick Bladder Disorder Emotional Wreck
  Fart Excessively Bushy Eyebrows Talk with Hands
  Contacts/Glasses Knuckle Cracker Excessive Blinking
  Currently seeing a Therapist?  
  Regularly use FUCK in your vocabulary  
     
Measuring Your Determination:
On a scale of 1 to 10, with 10 meaning "Very Freakin Seriously", how seriously are you committed to spreading - 'Burn The Word'?
   
     
Special skills: Language proficiency (other than English) Computer skills?
   
 
Please use the following to characterize yourself? (Choose all that apply)
  Leader Proactive Compassionate
  Logical Independent Understanding
  Quirky Eclectic Confident
       
Please list Five (5) people that will vouch for you:
   
 
Will you be available for phone and/or online debrief sessions Post Playa 2012?
  Yes  No      
# people you think you will convert to 'The Word of Larry' during your mission?
  1   2 - 5 5 - 10
  20 - 50 100 - 500 800 - 1600
  2000 - 5000 5000 - 10000 10000+
       
Please use the following to characterize Larry Harvey? (Choose all that apply)
  Rebellious Unique Generous
  Friendly Results-Driven Naive
  Open Minded Controversial Wise
     
     
   
     


2012 - Larry's Witnesses