NAME: _______________________________

• Ethnic Information: (voluntary)
• ____White
• Type of Cars Owned:
• ____Pickup Truck
• You don't own any Foreign cars, do you?
• ____NO
• Car Equipment:
• ____Gun Rack
• ____Stash
• ____CB
• ____Beer Holder
• ____Playboy air freshener
• Bumper Stickers:
• ____"Ex-wife in trunk"
• ____"If Guns are Outlawed, Only Outlaws Will Have Guns"
• ____"Bush/Quayle"
• ____"Shit Happens"
• ____"If you don't like my driving, get off the sidewalk"
• Sexual Orientation:
• ____Heterosexual
• Favorite Cause:
• ____NRA
• ____Prolife
• Total given to these causes in the last 12 months: ________________
• Favorite Drugs:
• ____Grass
• Seasonings used on Food:
• ____Ketchup
• ____Salt
• Which of the Following Should be Banned?: (check all that apply)
• ____Democrats
• ____Welfare
• ____N.O.W.
• Favorite Beer:
• ____Miller
• ____Michelob
• ____Bud
• Favoriite Politician:
• ____Don't Care
• Club Memberships:
• ____NRA
• How Many Automatic Weapons do you own?
• ____5
• ____10
• ____More than that
• Favorite TV Show
• ____Benny Hill