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: 196_
Do you have a gun rack? (_) Yes (_) No; If no, please explain:
Newspapers/magazines you subscribe to: (_) The National Enquirer (_) The Globe (_) TV Guide (_) Soap Opera Digest (_) Rifle and Shotgun
Number of times you've seen a UFO:_____
Number of times in the last 5 years 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 eyes: Left______ Right_____
Color of hair: (_) Blond (_) Black (_) Red (_) Brown (_) White (_) Clairol
Color of teeth: (_) Yellow (_) Light Brown (_) Brown (_) Black (_) N/A
Brand of chewing tobacco you prefer: (_)Red-Man (_)Other (Specify________________ )
How far is your home from a paved road? (_) 1 mile (_) 2 miles (_) just a whoop-and-a-holler (_) road?
