Name:
Nickname:
CB Handle:
Model: Color:
Address (RFD No.):
Daddy (If unknown, list 3 suspects):
Mamma:
Neck Shade:
[ ] Light Red / [ ] Medium Red / [ ] Dark Red
Number of teeth exposed in full grin: Upper Lower
Name of Pickup owned:
Height of Truck:
Truck equipped with:
[ ] Gun Rack / [ ] 4-Wheel Drive / [ ] Confederate Flag / [ ] 8-Track Cassettes / [ ] Load of Wood / [ ] Hijacker Shocks / [ ] Radar Detector / [ ] Mag Wheels / [ ] Dual CB Antennas / [ ] Spittoon / [ ] Camper Top / [ ] Air Horns / [ ] Mud Flaps / [ ] Toothpick Holder / [ ] Mud-Grip Tires / [ ] Raccoon Hide / [ ] Big Dog / [ ] Hunting Rifle
Number of empty beer cans on floorboard or in bed of pickup truck:
BUMPER STICKERS:
[ ] Eat more Possum
[ ] My other car is a piece of shit too
[ ] Honk if you love Jesus
[ ] If you ain't a cowboy you aint shit
[ ] Redman Chewing Tobacco
[ ] Wave if you're horny
[ ] Don't Like My Driving? Dial 1-800-Eat-Shit
[ ] If You Can Read This, Then You's Too Smart For Kentucky
[ ] I Brake For Nuthin'
[ ] National Rifle Association
Define the following (must be 90% correct):
- Grits
- Goobers
- Pinto Beans
- Collards
- Sidemeat
- Sawmill Gravy
- Turnip Salad
- Shit-on-a-Shingle
- Redeye Gravy
- Soppin' Syrup
- Cobbler
- Fatback
- Tote
- Chickin'Fry
- Poke
- Tater
- Pig Skins
- Okrie
- Shonuf
- Chitlins
Favorite Vocalist:
[ ] Reba McEntire / [ ] Conway Twitty / [ ] Loretta Lynn / [ ] Hank Williams Jr. / [ ] Randy Travis / [ ] Ray Wylie Hubbard / [ ] Tammy Wynette / [ ] Slim Whitman / [ ] Porter Wagoner / [ ] Willie Nelson / [ ] George Jones / [ ] Box Car Willie
Favorite Recreation:
[ ] Square Dancin' / [ ] Possum Huntin' / [ ] Skinny Dippin' / [ ] Craw Daddin' / [ ] Gospel Singin' / [ ] 4-Wheelin' / [ ] Drankin' / [ ] Spittin' Backy / [ ] Bill Chip Throwin' / [ ] Honky Tonkin' / [ ] Noodlin' / [ ] Other
Name of Son(s):
[ ] Bubba / [ ] Jim Bob / [ ] LeeRoy / [ ] J.D. / [ ] Bill Lee / [ ] Bob Lee / [ ] Duke
Name of Daughter(s):
[ ] PammySue / [ ] Violet / [ ] Paulette / [ ] Daisy
Weapons Owned:
[ ] Deer Rifle / [ ] Sawed-Off Shotgun / [ ] Varmit Rifle / [ ] Log Cabin / [ ] Tire Iron / [ ] Power Chain Saw / [ ] Pick Handle / [ ] Hick'ry Switch
Number of Dogs: Type:
[ ] Blue Tick / [ ] Beagle / [ ] Black & Tan / [ ] Bird Dawg
Cap Emblem:
[ ] John Deer / [ ] McCullock Chain Saws / [ ] Budweiser / [ ] Vo-Tech / [ ] Skoal / [ ] Coors / [ ] NAPA / [ ] Smile if You're Not Wearing Underwear / [ ] N.R.A. / [ ] Redman / [ ] Kodiak
Number of Dependends: Legal: Claimed:
Number of Weeks Unemployed:
Number of Welfare Checks Received:
Memberships:
[ ] KKK / [ ] NRA / [ ] Moose / [ ] PTL Club / [ ] AA / [ ] Bass Club / [ ] VFW / [ ] Quiltin' Bee / [ ] American Legion / [ ] United Sons/Daughters of the Confederacy / [ ] John Birch Society
Length of Right leg: Length of Left leg:
Number of Testicles Shot off in 'Nam: Number of Testicles Left:
Does your truck contain some part painted the offical state color of Primer Red? [ ] Yes [ ] No
How many cars do you have jacked up on blocks in your front yard?
How many kitchen appliances will you keep on your front porch?
Will you wear mostly double-knit polyester pants with snags?
Do you own any shoes? [ ] Yes [ ] No If yes, how many?
What year did you last purchase shoes?
Are you married to any of the following: [ ] Sister / [ ] Cousin / [ ] Sow
Do you know her name?
Does your wife weigh more than your pickup?
Can you sign your name and get the spelling right every time?
Have you ever stayed sober for a whole weekend?
If so, why?
Can you count:
Past 10 with your shoes on?
To 21 with your fly up?
Do you know any words that have more than four letters?
Have you ever had more than one bath in a week?
Medical Information:
Do you have at least two of the following:
[ ] BO / [ ] Crabs / [ ] Head Lice / [ ] Rabies / [ ] Trench Mouth / [ ] Runny Nose / [ ] Bad Breath / [ ] Chafing
IF YOUR APPLICATION IS TURNED DOWN BY THE STATE OF KENTUCKY, YOU MAY BE ELIGIBLE IN THE STATES OF TEXAS, OKLAHOMA, OR ARKANSAS. THEIR STANDARDS ARE SLIGHTLY LOWER, HOWEVER, YOU WOULD STILL BE ABLE TO VISIT KENTUCKY.
