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
Age: ____ (if unsure, guess)
Sex: ____ M _____ F _____ Not sure
Shoe Size: ____ Left ____ Right If no shoes,put nun_______
Occupation:
[_] Trailer Park Landlord
[_] Truckdriver
[_] Farmer
[_] Backyard Mechanic
[_] Hair Dresser
[_] Truckstop Waitress
[_] Waffle House Cook
[_] Unemployed
[_] Dirty Politician
[_] Moonshine Runner
Spouse's Name: __________________________
2nd Spouse's Name: _________________________
3rd Spouse's Name: _________________________
Lover's Name: ____________________________
2nd Lover's Name: __________________________
Relationship with spouse:
[_] Sister [_] Aunt
[_] Brother
[_] Uncle
[_] Mother
[_] Son
[_] Father
[_] Daughter
[_] Cousin
[_] Pet
Number of children living in household: ___
Number of children living in shed: ___
Number of children that are yours: ___
Number of outhouses ____
Mother's Name: _______________________
Father's Name: _______________________
(If not sure, leave blank)
Education: 1 2 3 4 5 6(Circle highest grade completed)
Do you [_] own or [_] rent your mobile home?
Year of mobile home 197_
Vehicles you own and where you keep them?
___ Total number of vehicles you own Cars_____ Trucks_____
___ Number of vehicles that still crank
___ Number of vehicles in front yard
___ Number of vehicles in back yard
___ Number of vehicles on cement blocks Cars_____ Trucks_____
How many firearms you own? ____
Where do you keep them?
____ truck
____ kitchen
____ bedroom
____ bathroom
____ shed
____ outhouse
____ with your wife's/significant other's camoflage lingerie
Model of your pickup: _____________
Year pickup produced: 197____
Do you have a gun rack?
[_] Yes [_] No; If no, please explain:_________________________
Newspapers/magazines you subscribe to?
[_] The National Enquirer
[_] The Globe
[_] High Times
[_] TV Guide
[_] Soap World
[_] Rifle and Shotgun
[_] BowHunter
[_] Nascar Illustrated
[_] Coloring Book, and crayons
[_] Can't read
___ Number of times you've seen a UFO
___ Number of times in 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
Where do you bathe?
[_] Kitchen sink
[_] Bathtub
[_] Creek
How many teeth do you have? ___
Color of teeth:
[_] Yellow
[_] Brownish-Yellow
[_] Brown
[_] Black
[_] None
Brand of flavor chewing tobacco you prefer:
[_] Winter Green
_______________
What kind of toothpaste do you use?
[_] Crest Advanced
[_] Pepsodent
[_] Ultrabrite
[_] None...Why bother
How far is your home from a paved road?
[_] 1 mile
[_] 2 miles
[_] what is a paved road?
Nearest racetrack from your trailer?
_________________
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
Age: ____ (if unsure, guess)
Sex: ____ M _____ F _____ Not sure
Shoe Size: ____ Left ____ Right If no shoes,put nun_______
Occupation:
[_] Trailer Park Landlord
[_] Truckdriver
[_] Farmer
[_] Backyard Mechanic
[_] Hair Dresser
[_] Truckstop Waitress
[_] Waffle House Cook
[_] Unemployed
[_] Dirty Politician
[_] Moonshine Runner
Spouse's Name: __________________________
2nd Spouse's Name: _________________________
3rd Spouse's Name: _________________________
Lover's Name: ____________________________
2nd Lover's Name: __________________________
Relationship with spouse:
[_] Sister [_] Aunt
[_] Brother
[_] Uncle
[_] Mother
[_] Son
[_] Father
[_] Daughter
[_] Cousin
[_] Pet
Number of children living in household: ___
Number of children living in shed: ___
Number of children that are yours: ___
Number of outhouses ____
Mother's Name: _______________________
Father's Name: _______________________
(If not sure, leave blank)
Education: 1 2 3 4 5 6(Circle highest grade completed)
Do you [_] own or [_] rent your mobile home?
Year of mobile home 197_
Vehicles you own and where you keep them?
___ Total number of vehicles you own Cars_____ Trucks_____
___ Number of vehicles that still crank
___ Number of vehicles in front yard
___ Number of vehicles in back yard
___ Number of vehicles on cement blocks Cars_____ Trucks_____
How many firearms you own? ____
Where do you keep them?
____ truck
____ kitchen
____ bedroom
____ bathroom
____ shed
____ outhouse
____ with your wife's/significant other's camoflage lingerie
Model of your pickup: _____________
Year pickup produced: 197____
Do you have a gun rack?
[_] Yes [_] No; If no, please explain:_________________________
Newspapers/magazines you subscribe to?
[_] The National Enquirer
[_] The Globe
[_] High Times
[_] TV Guide
[_] Soap World
[_] Rifle and Shotgun
[_] BowHunter
[_] Nascar Illustrated
[_] Coloring Book, and crayons
[_] Can't read
___ Number of times you've seen a UFO
___ Number of times in 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
Where do you bathe?
[_] Kitchen sink
[_] Bathtub
[_] Creek
How many teeth do you have? ___
Color of teeth:
[_] Yellow
[_] Brownish-Yellow
[_] Brown
[_] Black
[_] None
Brand of flavor chewing tobacco you prefer:
[_] Winter Green
_______________
What kind of toothpaste do you use?
[_] Crest Advanced
[_] Pepsodent
[_] Ultrabrite
[_] None...Why bother
How far is your home from a paved road?
[_] 1 mile
[_] 2 miles
[_] what is a paved road?
Nearest racetrack from your trailer?
_________________