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Name. Permanent address. Mailing address (if different).

Will you want me when I ask you to vacuum the stairs

with the hose attachment? Daytime telephone number.

when we are eating cabbage for the third straight night?

Evening. Cell. Email. when you hear my footsteps

descend the basement stairs during the Leafs game?

Date of birth. Sex. Marital status. Will you want me

when birds walk across my face? Employment

in the last two years. and I give up mowing

my legs? From. To. give up dusting my cheeks?

From. To. give up Restylane?

                                                      Emergency

contact information. when I sit on the toilet seat

of the ensuite weeping? Name. over a clot of blood?

Relationship. over nothing? Telephone. Would you if I migrate

Type of card. Name on card. Card number. if I start calling

you Mr. Shopkeeper? Date of expiry. if I keep asking you if

you'll be getting any milk soon for the baby?

(Optional) Choose a security question. Would you want me

if I lose a limb? Mother's maiden name. if I lose a breast?

Year of father's birth. Will you want me when

I declare the above statements are true. I lose half of me?

Signature. Date. and half of you?

Please Print Clearly in Block Letters

Ian Williams

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