radioEARTH
Hillbilly Application
Name: _________________ (first)
Name: _________________ (last)
(__) Billy-Bob
(__) Billy-Joe
(__) Billy-Ray
(__) Billy-Sue
(__) Billy-Mae
(__) Billy-Jack
(Check appropriate box)
Age: ___
Sex: ___ M ___ F ___ N/A
Shoe Size: ___ Left ___ Right
Previous Occupation:
(__) Farmer
(__) Mechanic
(__) Hair Dresser
(__) Un-employed
Spouse's Name: _________________________
Relationship with spouse:
(__) Sister
(__) Brother
(__) Aunt
(__) Uncle
(__) Cousin
(__) Mother
(__) Father
(__) Son
(__) Daughter
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?
(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: ____________ 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