By filling in this form you are saying and admitting that you are interested in becoming a Deviant. Let that be clear that you are looking to cause trouble and are interested in teaming up with me to do so.
All information listed will remain strictly confidential. I know how important your privacy can be so I want you to be rest assured that no one but myself will see this information. I mean I wouldn't want to jeopardize the image or reputation of a potentially good partner. So feel free to write what you want.