Last name: _______________________
First name: (Check appropriate box)
(_)Billy-Bob
(_)Billy-Joe
(_)Billy-Ray
(_)Billy-Sue
(_)Billy-Mae
(_)Billy-Jack
What does everyone call you?
(_)Booger
(_)Bubba
(_)Junior
(_)Sissy
(_)Other____________
Age:____ (if unsure,guess)
Sex:____ M ____ F ____Not sure
Shoe size:____ Left ____ Right
Occupation:(Check appropriate box)
(_)Farmer
(_)Mechanic
(_)Hair Dresser
(_)Unemployed
(_)Dirty Politician
(_)Preacher
Spouse's Name:_____________
2nd Spouse's Name:_______________
3rd Spouse's Name:_______________
Lover's Name:_______________
Relationship with spouse:(Check appropriate box)
(_)Sister
(_)Brother
(_)Aunt
(_)Uncle
(_)Cousin
(_)Mother
(_)Father
(_)Son
(_)Daughter
(_)Pet
Number of children living in the home:_____
Number of the children living in the shed:_____
Number that are yours:_____
Mother's Name:____________________(If not sure, leave blank)
Father's Name:____________________(If not sure, leave blank)
Education: 1 2 3 4 (Circle highest grade commpleted)
(Check appropriate box)
Total number of vehicles you own:___
Number of vehicles that still crank:___
Number of vehicles in front yard:___
Number of vehicles in the back yard:___
Number of vehicles on cement blocks:___
Firearms you own and where you keep them:
____truck
____bedroom
____bathroom
____kitchen
____shed
Model and year of your pickup:196_
Do you have a gun rack?
(_)Yes (_)No; If no, please explain:
Newspapers/magazines you subscribe to:
(_)The National Enquirer
(_)The Globe
(_)TV Guide
(_)Soap Opera Digest
(_)Rifle and Shotgun
Number of times you've seen a UFO:_____
Number of times in the last 5 years you've seen Elvis:___
Number of times you've seen Elvis in a UFO:____
How often do you bathe?
(_)Weekly
(_)Monthly
(_)Not Applicable
Color of eyes:
Left_____ Right_____
Color of hair:
(_)Blond
(_)Black
(_)Red
(_)Brown
(_)White
(_)Clairol
Color of teeth:
(_)White
(_)Yellow
(_)Brownish-Yellow
(_)Brown
(_)Black
(_)N/A
Brand of chewing tobacco you prefer:
(_)Red-Man
How far is your home from a paved road?
(_)1 mile
(_)2 miles
(_)just a whoop-and-a-holler
(_)road?
