Questionnaire

Last name: _________________

First name: (Check appropriate box)
[_] billy bob [_] Bobby-Sue [_] Billy-Joe [_] Bobby-Jo [_] Billy-Ray [_] Bobby-Ann [_] Billy-Sue [_] Bobby-Lee [_] Billy-Mae [_] Bobby-Ellen [_] Billy-Jack [_] Bobby-Beth Ann Sue

Age: ______ (if unsure, guess)

Sex: _____M_____F_____Not sure Shoe Size: _____Left_____Right

Occupation: [_] Farmer [_] Mechanic [_] Hair Dresser [_] Waitress [_] Unemployed [_] Dirty Politician

Spouse's Name_________________________ 2nd Spouse's Name: _________________ 3rd Spouse's Name: _________________

Lover's Name: ________________________ 2nd Lover's Name: ___________________

Relationship to spouse: [_] Sister [_] Aunt [_] Brother [_] Uncle [_] Mother [_] Son [_] Father [_] Daughter [_] Cousin [_] Pet

Number of children living in household: _____ Number of children living in shed: _____

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? ___ Total number of vehicles that 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

Where your firearms are kept: [_] truck [_] kitchen [_] bedroom [_] bathroom [_] shed

Model and year of your pickup: _______ 194_

Do you have a gun rack? [_] Yes [_] No; if no, please explain: _____________________

Newspapers/magazines you subscribe to: [_] 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
How many?_____

Brand of chewing tobacco you prefer: [_] Red-Man

How far is your home from a paved road? [_] 200-400 miles [_] over 400 miles [_] what's a miles?