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?







 ___ 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







 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