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 (_)Unemployed

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