- Name: (Check appropriate box)
- Age: ____
- Sex: ____ M _____ F _____ N/A
- Shoe Size: ____ Left ____ Right
- Spouse’s Name: __________________________
- Relationship with spouse:
- 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
- Model and year of your pickup: _____________ 194__
- Firearms you own and where you keep them:
- Do you have a gun rack?
____No; please explain:_______________________________________________________
- Newspapers/magazines you subscribe to:
____The National Enquirer
____Soap Opera Digest
____Rifle and Shotgun
- How many times have you:
____Seen a UFO?
____Been abducted by evil space aliens?
____Seen Elvis in a UFO?
- How often do you bathe:
- Color of teeth:
- Brand of chewing tobacco you prefer:
- How far is your home from a paved road?
____what’s a road?