Name: ________________        (_) Billy-Bob
                   (last)           (_) Billy-Joe
                                    (_) Billy-Ray
                                    (_) Billy-Sue
                                    (_) Billy-Mae
                                    (_) Billy-Jack
                                    (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_

       Do you have a gun rack?
       (_) Yes (_) 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
       ___ Number of times you've seen a UFO in Elvis

       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