:
: 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 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 highestgrade completed)

: Do you (_) own or (_) rent your mobile home?
: (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 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 aUFO:_____

: How often do you bathe:
: (_) Weekly
: (_) Monthly
: (_) Not Applicable

:
: Color of eyes:
: Left______ Right_____

:
: Color of hair:
: (_) Blonde
: (_) 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 pavedroad?
: (_) 1 mile
: (_) 2 miles
: (_) just a whoop-and-a-holler
: (_) road?