APPLICATION TO LIVE IN West Virginia
Name:____________ Nickname:____________ CB handle:___________
Address (RFD No.):_______________________
Daddy (if unknown, attach list of three suspects):_________________________
Mama:_______________ 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
() fuzz buster () mag wheels () dual CB antenna () raccoon hide
() spittoon () camper top () air horns () big dog
Number of empty beer cans on floor of pickup:______
Bumper stickers: () Eat More Possum () Honk If You Love Jesus
() Wave If You're Horny () Red Man Chewing Tobacco
Define the following (must get 90% correct):
1. grits 5. muscadine 9. cobbler 13. soppin syrup 17. chitlins
2. tater 6. sidemeat 10. fatback 14. redeye gravy 18. mountain oysters
3. tote 7. pig skins 11. collards 15. pinto beans 19. turnip salit
4. poke 8. goobers 12. crackers 16. sawmill gravy 20. shit on a shingle
Favorite vocalist:
() Donna Fargo () Conway Twitty () Loretta Lynn () Hank Williams
() Elvis () Johnny Cash () Tammy Wynette () Slim Whitman
() George Jones () Boxcar Willie () Porter Wagoner () Willie Nelson
Favorite recreation:
() squar dancin () possum huntin () skinny dippin () drankin
() craw daddin () gospel singin () 4-wheelin () bull chip throwin
() spittin backy () blue grass conventions () other
Cap Emblem:
() John Deere () CAT () McCulloch Chain Saws () Budweiser
() NAPA () Coors () Toro
Memberships:
() KKK () NRA () Moose () PTL Club () VFW () Bassmasters
() American Legion () United Sons/Daughters of Confederacy
Weapons owned:
() deer rifle () bird gun () log chain () power chain saw
() varmint rifle () tire iron () pick handle () sawed-off shotgun
Number of hound dogs:______ Type: () Blue Tick () Black & Tan () Beagle
Number of weeks unemployed:_______ Number of welfare checks received:_______
Number of dependents (legal):_____ (claimed):_____
Length of right leg:_________ Length of left leg:________
Does your truck have 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) do you have on your front porch?__
Will you be part of the West Virginia intelligentsia with an IQ greater than 65?
Do you wear mostly double knit polyester pants with snags?_____
Do you own any shoes?_____ If so, how many?______ How many matched pairs?____
What year did you last purchase shoes?_______
Are you married to any of the following:
() Sister () Cousin () Sow () Ewe () Other 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?_________________
Do you know any words that have more than 4 letters?_____ (if yes, attach list)
Can you count:
1) past 10 with your shoes on?_____ 2) to 21 with your fly up?_____
Medical information:
Do you have at least 2 of the following? () BO () Crabs () Head Lice
() Scabies () Trench Mouth () Runny Nose () Bad Breath
Have you ever stayed sober for a whole weekend?_____
Have you EVER had more than one bath in a week?_____
Spell Checked and reformatted by Nathan Mates (nathan@cco.caltech.edu)
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