Last name: _________________
First name: (Check appropriate box)
[] 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
Age: ______ (if unsure, guess)
Sex: _ M _ F ___ Not sure
Shoe Size: _ Left _ Right
Occupation:
[] Farmer [] Mechanic
[] Hair Dresser [] Waitress
[] Unemployed [] Dirty Politician
Spouse's Name: _________________________
2nd Spouse's Name: _________________
3rd Spouse's Name: _________________
Lover's Name: ________________________
2nd Lover's Name: ___________________
Relationship to spouse:
[] Sister [] Aunt
[] Brother [] Uncle
[] Mother [] Son
[] Father [] Daughter
[] Cousin [] Pet
Number of children living in household: _____
Number of children living in shed: _____
Number that are yours: _____
Mother's Name: ___________________
Father's Name: ___________________ (If not sure, leave blank)
Education: 1 2 3 4 (Circle highest grade completed)
Do you [] own or [] rent your mobile home?
___ Total number of vehicles that 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
Where your firearms are kept:
[] truck [] kitchen
[] bedroom [] bathroom
[_] shed
Model and year of your pickup: _______ 194_
Do you have a gun rack?
[] Yes [] No; if no, please explain: _____________________
Newspapers/magazines you subscribe to:
[] National Enquirer [] The Globe
[] TV Guide [] Soap Opera Digest
[_] Rifle and Shotgun
___ 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
How often do you bathe:
[_] Weekly
[_] Monthly
[_] Not applicable
Color of teeth:
[] Yellow [] Brownish-Yellow
[] Brown [] Black
[_] N/A How many?_____
Brand of chewing tobacco you prefer: [_] Red-Man
How far is your home from a paved road?
[_] 200-400 miles
[_] over 400 miles
[_] what's a miles?
