Last name: _________
First name: Billy Bob [ ] Billy Ray [ ]
Billy Joe [ ] Billy Sue [ ] Billy Mae [ ] Billy Jack [ ] Bobby Sue [ ] Bobby Jo [ ]
Bobby Ann [ ] Bobby Lee [ ] Bobby Ellen [ ]
Bobby Beth-Sue-Ann [ ]
Age:____ ( If unsure, guess )
Sex: [ __M] [ __F ] [ __N/A ]
Shoe size: Left- _____ Right- _____
Occupation: Farmer [ ] Hair-dresser [ ] Mechanic [ ] Waitress [ ] Dirty Politician [ ] Un-Employed [ ]
Spouse's Name: ______
Other Spouse's Name: _____
Lover's Name: _______
Other Lover's name: ______
Relationship to spouse: Mother [ ] Father [ ] Sister [ ] Brother [ ] Daughter [ ] Son [ ] Cousin [ ] Aunt [ ] Uncle [ ] Pet [ ]
Number of children living in household: _______
Number of children living in shed: _______
Number of children that are yours: _________
Mother's name: _______ ( If unsure, guess )
Father's name: _______ ( If unsure, guess )
Education : 1 2 3 4 ( Circle highest grade completed )
If you obtained a