Name: ________________ (_) Billy-Bob (last) (_) Billy-Joe (_) Billy-Ray (_) Billy-Sue (_) Billy-Mae (_) Billy-Jack (_) Billy-Jefferson (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_
Newspapers/magazines you subscribe to: (_)The National Enquirer (_)The Globe (_)TV Guide (_)Soap Opera Digest
___ 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