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Jan 18, 2005Comments: 0 · Posts: 13612 · Topics: 756
(Folks from Mississippi and Louisiana, please use the form with pictures)
? Last name: ________________
(Check appropriate box)
? First name: First name:
[_] 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
[_] Un-employed [_] Dirty Politician
? Spouse's Name: __________________________
? 2nd Spouse's Name: __________________________
? 3rd Spouse's Name: __________________________
? Lover's Name: __________________________
? 2nd Lover's Name: __________________________
? Relationship with spouse:
[_] Sister [_] Aunt
[_] Brother [_] Uncle
[_] Mother [_] Son
[_] Father [_] Daughter
[_] Cousin [_] Pet
Number of children living in household: ___
Number of children living in shed: ___
Number of children 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)
? Vehicles you own and where you keep them:
___ 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 ____ 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:
[_] The 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
? How many teeth? ___
? Colour 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
? PLEASE MAKE YOUR MARK HERE: ______________________