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'* Name:_________________________

2nd Spouse'* Name:______________________

3rd Spouse'* Name:______________________

Lover'* 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'* Name:______________________(If not sure, leave blank)

Father'* Name:______________________ (If not sure, leave blank)

Education: 1 2 3 4 (Circle highest grade 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: ___

Number of 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 a UFO:_____

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

Color of eyes:
Left______ Right_____

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?