OK SOMEONE MESSED UP...I AM ONLY 43 OR 42 CANT REMEMBER ...LOL~ BUT NOT 53 and I smoke sometimes
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Please show this on your profile if you know someone who has been eaten by a shark!


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Age: ____ (if unsure, guess)

Sex: [_]M [_]F [_]None

Shoe Size: ____ Left ____ Right _____ Other

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Occupation: [_] Farmer [_] Waitress
[_] Mechanic [_] Dirty Politician
[_] Hair Dresser [_] Un-employed

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Spouse's Name: __________________________
2nd Spouse's Name: __________________________
3rd Spouse's Name: __________________________
Lover's Name: __________________________
2nd Lover's Name: __________________________

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Relationship with spouse: [_] Sister [_] Aunt
[_] Brother [_] Uncle
[_] Mother [_] Father
[_] Son [_] Cousin
[_] Daughter [_] Pet

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Number of children living in household: ___
Number of children living in shed: ___
Number of children that are yours: ___

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Mother's Name: _______________________
Father's Name: _______________________

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Education: 1 2 3 4 (Circle highest grade completed)
If you obtained a higher education what was your
major?
[_] 5th grade [_] 6th grade [_] special classes

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Do you [_] own or [_] rent your mobile home?

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Vehicles you own and where you keep them:
___ 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

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Age you started drivin ______ (If over 10 are you
are still slow lerrnin ? [_] Yes [_] No)

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Firearms you own and where you keep them:
____ truck
____ kitchen
____ bedroom
____ bathroom/outhouse
____ shed
____ pawnshop

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Model and year of your pickup: _________
Do you have a gun rack?
[_] Yes [_] No; If no, please explain:

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Newspapers/magazines you subscribe to:
[_] The National Enquirer
[_] The Globe
[_] TV Guide
[_] Soap Opera Digest
[_] Rifle and Shotgun
[_] Bassmasters
[_] Hustler or Biker Magazine

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___ 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

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How often do you bathe:
[_] Weekly
[_] Monthly
[_] Not Applicable

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How many teeth in YOUR mouth? ___
Color of teeth:
[_] Yellow
[_] Brownish-Yellow
[_] Brown
[_] Black
[_] N/A

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Brand of chewing tobacco you prefer:
[_] Red-Man
[_] Skoal

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How far is your home from a paved road?
[_] 1 mile
[_] 2 miles
[_] don't know

Are you bi-sexual [_]yes [_]no [_]dont know
Can you cook [_]yes [_]no
If you answered yes what is your best meal, microwavable or canned or fresh?

Have you ever had sex with multiple partners [_]yes [_]no

What is your favorite thing to do?