- Name: ____________________________
- ____Billy-Bob
- ____Billy-Joe
- ____Billy-Ray
- ____Billy-Sue
- ____Billy-Mae
- ____Billy-Jack
(Check appropriate box)
- Age: ____
- Sex: ____ M _____ F _____ N/A
- Shoe Size: ____ Left ____ Right
- Occupation:
- ____Farmer
- ____Mechanic
- ____Hair Dresser
- ____Un-employed
- Spouse's Name: __________________________
- Relationship with spouse:
- ____Sister
- ____Brother
- ____Aunt
- ____Uncle
- ____Cousin
- ____Mother
- ____Father
- ____Son
- ____Daughter
- ____Pet
- Number of children living in household: ___
- Number that are yours: ___
- Mother's Name: _______________________
- Father's 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
- ____shed
- Model 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 you've seen 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
- 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
- ____don't know
- ____what's a road?