Last Name:

First Name: Billy-Bob Billy-Joe Billy-Mae Billy-Sue Billy-Jack Billy-Ray

What do people call you? Bubba Booger Sissy Jethro Cousin Bruce Other If other specify:

Age: (Guess if unsure)

Sex: Male Female Not sure

Shoe Size: What are shoes Right Left

Occupation: Farmer Mechanic Preacher

Spouse's Name:

Relationship with spouse: Sister Brother Uncle Cousin Aunt

Is your mobile home... Owned Leased Partially paid for Not sure

Number of Firearms and where you keep them: Kitchen Truck Bedroom Bathroom Shed

Do you have a Gun Rack? Yes No If no please explain.

Number of times you have seen a UFO Between 10-20 20-50 50-100 I can't count

Year of your Pickup: 196

How often do you bathe? Weekly Monthly Yearly I can't count

Education (Check highest grade completed) 1 2 3 4