1. Last Name__________________

2. First Name (select one) ____Billy-Bob                                     ____Billy-Sue ____Billy-Joe                                     ____Bobby-Jo(e) ____Billy-Ray                                     ____Bobby-Lee ____Billy-Jack                                     ____Bobby-Beth-Ann-Sue-Ellen
____momma was a yankee I only got
      one name

3. Age______ (if unsure, guess)

4. Sex______ (M, F, or U (unsure))

5. Shoe Size __Right __Other Right__

6. Occupation
___Farmer
___Mechanic
___Hair Dresser
___Waitress
___Un-employed
___Dirty Politician

7. Spouse's Name:___________________

8. 2nd Spouse's Name:_______________

9. 3rd Spouse's Name:_______________

10. Lover's Name:________________

11. Relationship to Spouse
___Sister
___Brother
___Aunt
___Mother
___Father
___Son
___Cousin
___Daughter
___Uncle
___Pet

12. Number of children living in
     household:_____

13. Number of children living in
     shed:______

14. Number of children that are
     yours:______

15. Mother's Name:__________________

16. Father's Name:__________________
        (If not sure, leave blank)

17. Education: 1 2 3 4
       (Circle hightest grade completed)

18. Do you ___own or ___rent your
     mobile home?

19. Vehicles you own?
___Total number of vehicles you own
___Number of vehicles that still run
___Number of vehicles in front yard
___Number up on blocks

19. Number of firearms you
     own:_______
    (Use seperate sheet for extra listings)

20. Model and year of your pickup
      truck:____________

21. Do you have a gun rack?
___Yes
___No (please explain in complete detail
         on back of form)

22. Newspapers/magazines you buy: ___The National Enquirer
___The Globe
___TV Guide
___Soap Opera Digest
___Rifle and Shotgun

23. Number of times you have seen a
     UFO:____

24. Number of times you have seen
     Elvis:____

25. Number of times you have seen
     Elvis in a UFO:___

 26. How often do you bathe:
___Weekly
___Monthly
___Not applicable

27. How far is your home from a paved
     road?
___1 mile
___2 miles
___Don't know

28. Number and type of lawn
     Ornaments displayed in your yard:
___Pink Flamingos
___Plastic pinwheels
___Cut out of lady bending over
___Other plastic animals
___Live goats and other critters