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) _____ 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 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?
(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 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?