Flatlanders Need Not Apply


Nickname CB Handle

Address (RFD)

Daddy (if unknown, attach list of three suspects)


Neck Shade Light Red Medium Red Dark Red

Number of Teeth Exposed in Full Grin Upper Lower

Make of Pickup Owned Size of Tires

Number of Empty Beer Cans on Floor of Pickup

Truck Equipped With:

Bumper Stickers:

Favorite Beverage:

Favorite Vocalist:

Favorite Recreation

Favorite Weapon:

Number of Hounds Type: Blue Tick Beagle Black & Tan

Cap Emblem:


Length of Right Leg Length of Left Leg

How many cars do you have up on blocks in your front yard?

How many kitchen appliances will you keep on your front porch? (Working or Not)

When was your last Elvis sighting?

Do you wear mostly polyester pants with snags?

Do you own any shoes (not counting boots), if so how many?

Are you married to any of the following?

Sister Cousin Cousin's Sister Sow

Does your wife weigh more than your pickup?

Can you sign your name and spell it right every time?

Have you ever stayed sober for a whole weekend?

Can you count: Past 10 with your shoes on? Past 21 with your fly up?

Have you EVER had more than one bath in a week? Month?

Medical Information (Do you have at least 2 of the following?):

Your Signature (one "X" will do)