One Nation Membership Form

         

      Name: ________________
                              (_) Billy-Bob
                              (_) Billy-Joe
                              (_) Billy-Ray
                              (_) Billy-Sue
                              (_) Billy-Mae
                              (_) Billy-Polly
                              (_) Billy-Pauline
      (Check appropriate box)

      Age: ____

      Sex: ____ M _____ F _____ N/A

      Shoe Size: ____ Left ____ Right

      Occupation:
                 (_) Farmer
                 (_) Mechanic/ Taxi Driver
                 (_) Fish and Chip Shop Owner
                 (_) Skinhead

     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,
       leaveblank)

      Education: 1 2 3 4 (Circle highest grade completed)

     Do you (_)own or (_)rent your caravan?  (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 blocks

      Firearms you own and where you keep them:
        ____ ute
        ____ truck
        ____ bedroom
        ____ bathroom
        ____ kitchen
        ____ shed

      Model and year of your Ute: _____________ 194_

      Do you have a gun rack?  (_) Yes (_) No; please explain:

      Newspapers/magazines you subscribe to:
         (_) The  Truth       (_) Exposure
         (_) TV Week          (_) Soap Opera Digest
         (_) Guns & Ammo      (_) Lock,Stock & Barrel

        ___ 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
         (_)Skoal

      How far is your home from a paved road?
         (_)1 km
         (_)2 km
         (_)5 km
         (_)don't know