APPLICATION TO LIVE IN WEST VIRGINIA

APPLICATION TO LIVE IN WEST VIRGINIA

 Name:______________  Nickname:____________  CB Handle:____________  
 Address: (RFD):_________________________________________________  
 Daddy: (If unknown attach list of three suspects):_____________________  
 Mamma:_______________________________  
 Neck Shade:   []  Light Red   []  Medium Red   []  Dark Red  
 Number of teeth exposed in full grin:  Upper:______  Lower:________  
 Name of Pickup Owned:______________  Height of truck:__________  
 Truck Equipped with:   []  Gun Rack  []  4-Wheel Drive  []  Confederate Flag  []  Toothpick Holder   []  8-Track   []  Load of Wood   []  Hijacker Shocks   []  Mud-grip Tires   []  Big Dog   []  Racoon Hide    []  Dual CB Antenna   []  Fuzz Buster   []  Spitoon   []  Camper Top     []  Mag Wheels        []  Air Horns    []  Mud Flaps  
 Number of Empty Beer Cans on Floor Board of Pickup:_________  
 Bumper Stickers:      []  Eat More Possum   []  Peanut Butter    []  Honk if You Love Jesus      []  Wave if You're Horny                  []  Redman Chewing Tobacco  
 Define the following (Must be 90% correct):   []  Grits      []  Muscadine       []  Cobbler   []  Tater   []  Goobers    []  Brogans         []  Fatback   []  Pig Skins   []  Collards   []  Redeye Gravy    []  Tote      []  Pinto Beans   []  Sidemeat   []  Sawmill Gravy   []  Poke      []  Turnip Salit   []  Chitlins   []  Soppin Syrup    []  Cracker   []  Shit-on-Shingle   []  Ramps  
 Favorite Vocalist:   []  Donna Fargo   []  Conway Twitty   []  Loretta Lynn    []  Hank Williams   []  Elvis         []  Slim Whitman    []  Tammy Wynette   []  Porter Wagoner   []  Johnny Cash   []  Willie Nelson   []  George Jones    []  Box Car Willie  
 Favorite Recreation:   []  Square Dancin'   []  Possum Huntin'      []  Skinny Dippin'   []  Craw Daddin'     []  Gospel Singin'      []  4-Wheelin'   []  Drankin'         []  Bull Chip Throwin'  []  Blue Grass Conventions   []  Spitten' backy   []  Other  
 Weapons Owned:   []  Deer Rifle    []  Bird Gun      []  Varmit Rifle   []  Sawed-off Shotgun   []  Tire Iron     []  Pick Handle   []  Log Chain      []  Power (chain) saw  
 Number of Hound Dogs:___  Type:   []  Blue Tick   []  Black & Tan   []  Beagle  
 Emblem:   []  John Deere   []  CAT    []  Budweiser   []  McCullock Chain Saw            []  PBR          []  NAPA   []  Coors       []  Skoals  
 Number of Weeks Unemployed:_____   Number of Welfare Checks Received:_____  
 Number of Dependents (Legal):______   (Claimed):______  
 Memberships:   []  KKK    []  NRA   []  Moose   []  PTL Club   []  VFW   []  American Legion   []  Bass Club       []  United Sons/Daughters of the Confederacy  
 Length of Left Leg:______  Length of Right Leg:______  
 Does your truck contain some part painted the official state color,  Primer Red?______  
 How many cars do you have jacked up on blocks in your front yard?______  
 How many kitchen appliances (working or not) will you keep on your front  porch?______  
 Will you be a part of the West Virginia Intelligentsia with a measurable  IQ?______  
 Do you wear mostly double knit polyester pants with snags?______  
 Do you own any shoes, if so how many?  ______    What year did you last purchase shoes? ______  
 Are you married to any of the following?   []  Sister   []  Cousin   []  Sow    Do you know her name? ______  
 Does your wife weigh more than your pickup?______  
 Can you sign your name and get the spelling right every time?______  
 Have you ever stayed sober for a whole weekend?______  
 Can you count:  Past 10 with your shoes on? ______                  To 21 with your fly up? ______  
 Medical Information:    Do you have at least 2 of the following:           []  BO       []  Crabs          []  Head Lice   []  Bad Breath         []  Scabies  []  Trench Mouth   []  Runny Nose  
 Do you know any words that have more than 4 letters?______  
 Have you EVER had more than one bath in a week? ______