Name:_____________
Nickname:__________
CB Handle:__________
Daddy, (if unknown list of 3 suspects)_____________________________________
Neck: ( ) Lt.Red  ( ) Med. Red  ( ) Dark Red  ( ) Other Red_____________________
Number of teeth exposed in full grin:______Upper  ________Lower
Make of Pickup:___________________Size of tire:___________________________
Hounds:________Type:  ( ) Blue tick  ( ) Beagle  ( ) Bassett  ( )  Other:________
Length of right leg:_________________Length of left leg:_______________________
How many cars/trucks in front yard:_______ How many up on blocks:____________
How many kitchen appliances on front porch:___________Back porch:___________
When and where was your last Elvis sighting?_________________________________
Do you wear mostly camouflage to church? ( ) yes  ( ) no
Do you own any shoes (not boots)  ( ) yes  ( ) no
Are you married to any of the following? (check all that apply):
         ( ) sister   ( ) cousin   ( ) cousins sister     ( )aunt    ( ) other:____________________
Does your wife weigh more than your pickup?  ( ) yes  ( ) no
Can you sign your own name and always spell it right?  ( ) yes ( ) no
Have you EVER had more than one bath in a week?  ( ) yes  ( )no
Can you count past ten with your shoes on?  ( ) yes       ( )no
Can you count past twenty with your fly up?   ( ) yes       ( )no
Favorite weapon:  ( ) Tire iron        ( ) wife's mouth            ( ) Logchain          ( ) Shot gun
Favorite pasttime:  ( ) Drinkin'   ( ) Coon huntin'            ( )Fishin'      ( ) 4 wheelin'
Truck equipped with: ( ) Gun rack      ( ) Fuzzbuster  ( ) $3,000 Stereo System in a $200 truck
                                 ( ) Rebel flag      ( ) Roll bar        ( ) CB radio   ( ) Beer cans  ( ) Squirrel tail
Favorite singer:        ( ) Willie Nelson           ( ) Johnny Cash            ( ) Elvis     ( ) Reba MacEntyre
                               ( ) Alan Jackson        ( ) Garth Brooks
Bumper stickers:  ( ) Honk if you love Jesus           ( ) Dial 1-800-EAT-SHIT
Cap emblems:  ( ) John Deere     ( ) Old Fart            ( ) CAT       ( ) SKOAL     ( ) Nascar
                        ( ) Budweiser           ( ) Jack Daniels
Memberships:  ( ) NRA          ( ) VFW         ( ) KKK                 ( ) 700 Club
MEDICAL INFORMATION:  Do you have at least 2 of the following?(check all  that apply)
( ) Bad breath                       ( ) Jock itch                   ( ) B.O.                   ( ) Crabs
( ) Lice     ( ) Crossed eyes                ( ) Tattoos             ( ) Athletes foot
( ) Runny nose                       ( ) Green teeth       ( ) Yellow teeth       ( ) Hemmoroids
( ) Rash of unknown origin          ( ) Missing teeth (how many:____)
Signature: (One X will do): ___________Date: