Redneck Aplikatshun

Name: ________________

    (_) Billy-Bob
    (_) Billy-Joe
    (_) Billy-Ray
    (_) Billy-Sue
    (_) Billy-Mae
    (_) Billy-Jack
    (_) Billy-Jefferson
(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

___ 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