Please read all the instructions carefully before proceeding.
Use only permanent blue or black ink.
If you have special needs that require accommodation,
The information you provide should not be limited
by the space allowed.
If you require more space, append another sheet of paper.
In the blanks below please provide us with the following:
your family name, your surname, your given names.
In the spaces provided below please list your middle name,
your married name, your maiden name.
Please write your name exactly as it appears.
Do not neglect to include the names
of your clan, your forefathers, the name that is known
for miles around your ancestral home as synonymous
with a high-ridged nose, a scholarly bent, a particular
branch of expertise.
If more space is required, append
another sheet of standard-size paper.
Please print clearly the names your mother rehearsed
while you wriggled for leeway inside her.
In the blanks below,
fill in the schoolyard spit-ringed
slurs and concocted superhero monikers.
What handle foiled the forum’s pingbacks?
Whose incognito initials bit into bark?
What property was signed away to the sand?
What petition was authored by indignation?
What name did you blurt in your sleep, the one
you never betrayed? What epithet couldn’t fly
past the watchtower; couldn’t be sounded
safely by patrols on night duty? Please release
your traceable aliases. Don’t limit yourself
to the space provided. In the forms and voids
intended for this express purpose. Please give us details
that will identify you and facilitate this process.