Personal Information: Name___________
Nickname______________
CB Handle______________
Yore Mama______________
Yore Daddy (if known)________________
Spouse's Name_________________
Relationship to spouse:
__Sister _ Brother__Mother__Father _Pet _Aunt _Uncle
Occupation:
___Unemployed Mechanic ___Gun Show Dealer___Skinhead
Number of Children in Household____
Number that are yours___
Circle Highest Level of Education: 1 2 3 4
How Far is Your Mobile Home From a Paved Road:
___1mi. __5 mi. ___?
Number of Times You Have Survived a Tornado:___
Number of Vehicles Owned:____
Number on Cement Blocks____
Truck Equipment: ___Gun Rack ___Pit Bull ___SpitCup ___Fuzzy
Dice___Rebel Flag ___Naked Woman Mudflaps ___NWO and/or NRA sticker
Weapons Owned:
___Tire Iron ___Pick Handle ___Beer Bottle ___Shotgun
Number of Dogs Owned:____
Number of Homemade Tattoos:____
Which of the Following Appliances are in your front Yard:
___Friggerator ___Heatin Stove ___Warsher___TV___Freezer
How Many of the Above Appliances Work:____
Fav-o-rite Recreation:
___Drinkin ___Cow Chip Throwin ___Possum Huntin___Crawdad Huntin
___Spittin Backy ___Scratchin___Watchin Wrasslin
If You Can Read, Which Magazines Do You Prefer:
___Soap Opera Digest ___NWA ___Rifle and Shotgun ___NWA___TV Guide
__National Enquirer __True Confessions
Which Stinks Worse: ___Hogpen ___Outhouse___Spouse
Can You Spell Your Last Name:___Yup ___Nope
Can You Remember Your Last Name:___Yup ___Nope
Have You Ever Stayed Sober for More Than One Day:___Yup ___Nope
Do You Know Any Words with More Than 4 Letters:___Yup ___Nope
Which is Correct?: ___"I Seed Him" or ___"I Seen Him"
How Many Cartons of Cigarettes Do You Smoke a Day?___
Math Test: How Many Food Stamps Do the Following Cost?
___Six Pack ___Ciggies ___Shotgun Shells ___Backy___Prostitute
Number of Times You've Seen:
___a UFO ___ Elvis___Elvis in a UFO
Health Questionaire: Which of the Following Do You Have?
___Head Lice ___B.O. ___Crabs ___Runny Nose___Boils
Can You Remember the Last Time You Bathed?___yup___nope
Color of Teeth:
___Yellow ___Brown ___Black ___N/A
I hereby swear this is the trooth and sign my "X" on
_________19__

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HOW TO KEEP A HEALTHY LEVEL OF INSANITY

01) At lunch time, sit in your parked car and point a hair dryer at passing cars to see if they slow down.
02) Page yourself over the intercom. (Don't disguise your voice.)
03) Insist that your e mail address is:Xena-goddess-of-fire@companyname.com Elvis-the-King@companyname.com.
04) Every time someone asks you to do something, ask if they want fries with that.
05) Encourage your colleagues to join you in a little synchronized chair dancing.
06) Put your garbage can on your desk and label it "IN."
07) Develop an unnatural fear of staplers. 08) Put decaf in the coffee maker for 3 weeks. Once everyone has gotten over their caffeine addictions, switch to espresso.
09) In the memo field of all your checks, write 'for sexual favors.'
10) Reply to everything someone says with, "That's what you think."
11) Finish all your sentences with "In accordance with the prophecy."
12) Adjust the tint on your monitor so that the brightness level lights up the entire work area. Insist to others that you like it that way.
13) Don't use any punctuation
14) As often as possible, skip rather than walk.
15) Ask people what sex they are.
16) Specify that your drive-through order is "to go."
17) Sing Along at the opera.
18) Go to a poetry recital and ask why the poems don't rhyme.
19) Find out where your boss shops and buy exactly the same outfits. Wear them one day after your boss does. (This is especially effective if your boss is the opposite gender.)
20) Send e-mail to the rest of the company to tell them what you're doing.
For example: If anyone needs me, I'll be in the bathroom.
21) Put mosquito netting around your cubicle.
22) Five days in advance, tell your friends you can't attend their party because you're not in>the mood.
23) Call 911 and ask if 911 is for emergencies
24) Call the psychic hotline and just say, "Guess"
25) Have your co-workers address you by your wrestling name, Rock Hard.
26) When the money comes out of the ATM, scream "I Won!", "I Won!" "3rd time this week!!!"
27) When leaving the Zoo, start running towards the parking lot, yelling "Run for your lives, they're loose!"
28) Tell your boss, "It's not the voices in my head that bother me, its the voices in your head that do"
29) Tell your children over dinner. "Due to the economy, we are going to have to let one of you go"
30) Every time you see a broom yell "Honey, your mother is here"