Last name: ________________
First name:
[_] Billy-Bob [_] Bobby-Sue
[_] Billy-Joe [_] Bobby-Jo
[_] Billy-Ray [_] Bobby-Ann
[_] Billy-Sue [_] Bobby-Lee
[_] Billy-Mae[_] Bobby-Ellen
[_] Billy-Jack [_] Bobby-Beth Ann Sue
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Age: ____ (if unsure, guess)
Sex: [_]M [_]F [_]None
Shoe Size: ____ Left ____ Right
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Occupation: [_] Farmer [_] Waitress [_] Mechanic
[_] Dirty Politician [_] Hair Dresser [_] Un-employed
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Spouse's Name: ______________________
2nd Spouse's Name: __________________
3rd Spouse's Name: __________________
Lover's Name: _______________________
2nd Lover's Name: ___________________
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Relationship with spouse: [_] Sister [_] Aunt
[_] Brother [_] Uncle [_] Mother [_] Father
[_] Son [_] Cousin [_] Daughter [_] Pet
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Number of children living in household: ___
Number of children living in shed: ___
Number of children that are yours: ___
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Education: 1 2 3 4 (Circle highest grade completed)
If higher education what was your major?
[_] 5th grade [_] 6th grade
Do you [_] Own [_] Rent your mobile home?
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Vehicles you own and where you keep them:
___ 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
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Firearms you own and where you keep them:
[_] truck [_] kitchen [_] bedroom
[_] bathroom/outhouse [_] shed [_] pawnshop
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Model and year of your pickup: _______ 194_
Do you have a gun rack?
[_] Yes [_] No; If no, please explain:
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Newspapers/magazines you subscribe to:
[_] The National Enquirer [_] TV Guide
[_] Soap Opera Digest [_] Bassmasters
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___ Number of times you've seen a UFO
___ Number of times you've seen Elvis
___ Number of times you've seen Elvis in a UFO
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How far is your home from a paved road?
[_] 1 mile
[_] 2 miles
[_] don't know
