Last Name: ____________________
First: (_) Billy-Bob (_) 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_
Newspapers/magazines you subscribe to:
(_)The National Enquirer
(_)The Globe
(_)TV Guide
(_)Soap Opera Digest
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
(_)what is a paved road?
***TOUR***