posted 03-28- 12:57 AM               

* Last name: ________________

* First name: (Check appropriate box)
* (_) Billy-Bob
* (_) Billy-Joe
* (_) Billy-Ray
* (_) Billy-Sue
* (_) Billy-Mae
* (_) Billy-Jack

* What does everyone call you?
* (_) 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?