[_] The National Enquirer [_] The Globe
[_] TV Guide [_] Soap Opera Digest
[_] Rifle and Shotgun
____No. of times you've seeen a U.F.O
____No. of times you've seen Elvis
____No. of times you've seen Elvis in a U.F.O.
How often do you bathe?
[_] Weekly
[_] monthly
[_] not applicable
How many teeth? ____
Color?
[_] 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
