Last Name: ________________ First Name (select one):
(_) Billy-Bob
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-JackAge: ____
Sex: ____ M _____ F _____ N/A
Shoe Size ____ Left ____ Right

Occupation:
(_) Farmer
(_) Mechanic
(_) Hair Dresser
(_) Un-employed

Spouses Name: __________________________Relationship with spouse:
(_) Sister
(_) Brother
(_) Aunt
(_) Uncle
(_) Cousin
(_) Mother
(_) Father
(_) Son
(_) Daughter
(_) Pet

Number of children living in household: ___Number that are yours: ___

Mothers Name: _______________________Fathers 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

Firearms you own and where you keep them:
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shedModel and year of your pickup: _____________ 194_

Do you have a gun rack?
(_) Yes (_) No please explain:

Newspapers/magazines you subscribe to:
(_) The National Enquirer
(_) The Globe
(_) TV Guide
(_) Soap Opera Digest
(_) Rifle and Shotgun___ Number of times youve seen a UFO

___ Number of times youve seen Elvis

___ Number of times youve seen Elvis in a UFO

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

Color of teeth:
(_)Yellow
(_)Brownish-Yellow
(_)Brown
(_)Black
(_)N/ABrand of chewing tobacco you prefer:
(_)Red-Man

How far is your home from a paved road?
(_)1 mile
(_)2 miles
(_)dont know