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
