NAME: _______________________________

1. Ethnic Information: (voluntary)
   ____White
2. Type of Cars Owned:
   ____Pickup Truck
3. You don’t own any Foreign cars, do you?
   ____NO
4. Car Equipment:
   ____Gun Rack
   ____Stash
   ____CB
   ____Beer Holder
   ____Playboy air freshener
5. Bumper Stickers:
   ____”Ex-wife in trunk”
   ____”If Guns are Outlawed, Only Outlaws Will Have Guns”
   ____”Romney/Ryan”
   ____”Shit Happens”
   ____”If you don’t like my driving, get off the sidewalk”
6. Sexual Orientation:
   ____Heterosexual
7. Favorite Cause:
   ____NRA
   ____Prolife
   Total given to these causes in the last 12 months: ________________
8. Favorite Drugs:
   ____Grass
9. Seasonings used on Food:
   ____Ketchup
   ____Salt
10. Which of the Following Should be Banned?: (check all that apply)
    ____Democrats
    ____Welfare
    ____N.O.W.
11. Favorite Beer:
    ____Miller
    ____Michelob
    ____Bud
12. Favorite Politician:
    ____Don’t Care
13. Club Memberships:
    ____NRA
14. How Many Automatic Weapons do you own?
    ____5
    ____10
    ____More than that
15. Favorite TV Show:
    ____Courage, New Hampshire
    ____Sons of Anarchy