Male or female (m/f): _____
First 3 letters of mother's maiden name: _____
_____ _____
First two letters of the month you were born: _____ _____
Last two digits of your zip code: _____ _____
For example, Dr. G's code is mBarMa03 because he is male, his mother's maiden name is Barnett, he was born in May, and his zip code ends in 03.