Arkansas State Registration FormLAST NAME: _______
FIRST NAME: (check one)
_____ Billy-Bob
_____ Billy-Ray
_____ Billy-Sue
_____ Billy-Mae
_____ Billy-Jack
_____ Billy-Bob
AGE: _____
SEX: _____ M _____ F _____ N/A
SHOE SIZE: _____ Left _____ Right
OCCUPATION: (check one)
_____ Farmer
_____ Mechanic
_____ Hair Dresser
_____ Unemployed
SPOUSE'S NAME: __________
RELATIONSHIP TO SPOUSE: (check one)
_____ 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, leave blank)
EDUCATION: 1 2 3 4 (Circle highest grade completed)
DO YOU _____ OWN OR _____ RENT YOUR MOBILE HOME?
_____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: __________194_
NEWSPAPERS/MAGAZINES YOU SUBSCRIBE TO:
_____ The National Enquirer
_____ The Globe
_____ TV Guide
_____ Soap Opera Digest
_____ 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
HOW FAR IS YOUR HOME FROM A PAVED ROAD?
_____ 1 mile
_____ 2 miles
_____ Don't know
Just kidding folks!
