first name: (tick 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)

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 household:

_____

number of children living in 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 completed)

total number of vehicles you own:

___

number of vehicles that still crank:

___

number of vehicles in front yard:

___

number of vehicles in 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:

[ ]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:

right_____ left _____

color of hair:

[ ]blond

[ ]black

[ ]red

[ ]brown

[ ]white

[ ]clairol

color of teeth:

[ ]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?