Professional Documents
Culture Documents
The Mutant Experience Form Pack
The Mutant Experience Form Pack
TM & Copyright © 1983, 1987, 2005 by Eric Goldberg & Greg Costikyan. All Rights Reserved. Mongoose Publishing Ltd., Authorized User.
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Mutation Registration Form
Distributed by Department 72 in coordination with the Office of Forms and Vouchers, PLC
Name __________________________-____-_______-____
Date and time ____________________________________ ATTACH TISSUE SAMPLE HERE
! Yes ! No I have been on the premises of a nuclear reactor within the last three months.
! Yes ! No I have watched more than two complete episodes of the Best Good Happy Sector Hour.
! Yes ! No I have heard of the secret society known as ‘Psion.’
! Yes ! No If given the choice, I would opt to terminate myself in hopes that my next clone would not suffer from this mutation.
! Yes ! No 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?
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 process-
ing 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
Suspicion of Mutant Activity Report Form
Distributed by Department 72 in coordination with the Office of Forms and Vouchers, PLC
Name ________________________-____-_______-____
Location (current) _______________________________ Location (of suspicious activity) _____________________
Date and time (current) ___________________________ Date and time (of suspicious activity) ________________
Height (current) _________________________________
Weight (current) _________________________________
Sanitation grade (current) _________________________ ! Yes ! No I am unusually thirsty today.
! Yes ! No My jumpsuit fits perfectly.
No. of mutants killed (career) ______________________ ! Yes ! No I have never failed The Computer.
No. of mutants turned in (career)____________________
FOR AUTHORIZED USE ONLY List all pharmaceuticals administered to you in the 24 hours prior
to the observed event:
Additional notes
Loyalty index _____________
Credibility index _____________
Transition rating _____________
What did you do to document the suspicious activity? How did the suspicious activity make you feel?
What sort of mutation do you think was involved? Where did you learn about this mutation?
Who do you believe was ultimately responsible? Why? Why should we believe you?
The average handling time for this form is between TWO MINUTES and SEVEN WEEKS. Re-submitting an identical copy of this form will not expedite processing
in any way. All witnesses of a suspicious event must submit separate paperwork. Unauthorized discussion of events prior to filing said paperwork is treason. If you need
to alter or amend any information on this form, resubmit it with an attached Report Modification Rider (993-52-H1996). By submitting this report, you authorize Internal
Security and/or other duly authorized representatives of The Computer to contact you about it at any time of day or night in a method of their choosing.
Form N73G-59O.7
Standard Affidavit of Registered Mutant Status
Distributed by Department 72 in coordination with the Office of Forms and Vouchers, PLC
Carry this affidavit on your person at all times. You are required by law to display it to any authorized citizen who requests to see it.
Should this paperwork become lost or damaged, you must immediately file an 83-992/C: Affidavit Replacement Request Form, Type S.
WARNING: Unauthorized modification of this paperwork is a class KK/1 Treasonous Act!
The following individuals are authorized to view Section 2: SECTION 2: LOYALTY & HAPPINESS REGIMEN
The bearer Medication Dosage Frequency
The bearer’s medication supervisor ! ____________ ____________
Internal Security personnel ! ____________ ____________
! ____________ ____________
The following individuals may be authorized to view Section 2: ! ____________ ____________
! Citizens above the bearer’s security clearance ! ____________ ____________
! Citizens of at least GREEN Clearance ! ____________ ____________
! Any and all supervisors, managers, team leaders, ! ____________ ____________
coordinators or other direct superiors of the bearer ! ____________ ____________
! The bearer’s registration contact ! ____________ ____________
! R&D personnel ! ____________ ____________
! HPD&MC personnel
! Citizens medically certified at grade E7 or better Additional instructions:
! Citizens carrying more weaponry than the bearer
! Citizens permitted to view Section 1
! Citizens permitted to view Section 3
! Other: ___________________________________ The following individuals are authorized to view Section 3:
The bearer
Armed Forces personnel on active duty
SECTION 3: MUTANT POWER Internal Security personnel
Mutation (common name) __________________________
The following individuals may be authorized to view Section 3:
Stratworth code __________________________________
Power level
! All citizens
! Citizens of at least GREEN Clearance
! Low ! Unknown ! Citizens with unregistered mutations
! Medium ! Classified (see pub. 6697/MH-2) ! The bearer’s registration contact
! High ! R&D personnel
Danger level ! Tech Services personnel
! Low ! Unknown ! Power Services personnel
! Medium ! Classified (see pub. 839-1-14.6) ! Steven-B-XMR-3
! High ! Citizens permitted to view Section 1
Permissible uses:
! Citizens permitted to view Section 2
! Other: ___________________________________
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4A. Have you seen Teela O’Malley fighting 3B. How did it make you feel? 8A. If the sum of your answers to 2A, 2B
mutants? ! Yes ! No and 2C is less than 4, answer question
If ‘yes,’ answer Question 3B. 6A. If less than 8, continue with 8E.
5A. Have you ever fought a mutant? Continue with appropriate sub-question 8D. Have you ever tried to mutate yourself?
! Yes ! No C. ! Yes ! No
If ‘yes,’ answer Question 3B. If ‘yes,’ answer question 5C.
4C. Did she do a good job?
6B. Have you ever wondered if you might 6A. Have you discussed this with Internal
be a mutant? Security?
! Yes ! No ! Yes ! No
If ‘yes,’ answer Question 3B. Continue from your origin. If ‘no’, go to the appropriate sub-
5C. Were you successful? question D and continue from there.
7C. How many mutations could you name
offhand? ______ 7D. Do you think you ought to be termi-
If less than 5, continue with 8B. If more nated?
than 10, answer question 6A. Continue from your origin with the next ! Yes ! No
question to have a higher number. If ‘no’, go to question 6C.
7A. Do you worry about exposure to muta-
gens? ! Yes ! No 6C. What makes you think this? 7E. Please report to Office 72.15-B /KVF.
8B. If you checked fewer than six choices
on question 1A, answer question 6A. 9A. See question 6A.
8E. Have you ever assisted a mutant? Continue with appropriate sub-question 9D. See question 7E.
! Yes ! No A.
If ‘yes,’ answer Question 6A now. 6D. Go to question 8A.
3A. Why are you ignoring the instructions?
3D. You are hereby fined 20 credits.
10A. Move on to the essay section. Answer question 6A now. 11A. Please report to Office 8.82-K/JJM.
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, don’t, 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