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	Air Horns
8-Track	Load of Wood	Hijacker shocks	Camper Top
Fuzz Buster	Mag Wheels	Dual CB Antenna	Racoon Hide
Spitoon	Mud-Grip Tires	Toothpick Holder	Big Dog

Number of Empty Beer Cans on Floor Board of Pickup:

Bumper Stickers:

	Peanut Butter
Honk if you love Jesus	Wave if you're Horny
Redman Chewing Tobacco	Eat More Possum

Define the following (Must be 90% Correct):

01. Grits	06. Muscadine	11. Cobbler	16. Tater	21. Ramps
02. Goobers	07. Brogans	12. Fatback	17. Pig Skins
03. Collards	08. Redeye Gravy	13. Tote	18. Pinto Beans
04. Sidemeat	09. Sawmill Gravy	14. Poke	19. Turnip Salit
05. Chitlins	10. Soppin Syrup	15. Cracker	20. Shit-on-the-Shingle

Favorite Vocalist:

Donna Fargo	Conway Twitty	Loretta Lynn	Hank Williams
Elvis	Johnny Cash	Tammy Wynette	Slim Whitman
Porter Wagoner	Willie Nelson	George Jones	Box Car Willie

Favorite Recreation:

Square Dancin'	Possum Huntin'	Skinny Dippin'	Craw Daddin'
Gospel Singin'	4-Wheelin'	Drankin'	Blue Grass Conventions
Spittin' Backy	Bull Chip Throwin'	Other

Weapons Owned:

Deer Rifle	Bird Gun	Varmit Rifle
Log Chain	Tire Iron	Pick Handle
Sawed-off Shotgun	Power (chain)

Number of Hound Dogs:
Type:
  Blue Tick   Black & Tan   Beagle

Cap Emblem:

John Deere	McCullock Chain Saws	CAT	PBR
Coors	Budweiser	NAPA	Skoals

Number of weeks Unemployed: Number of Welfare Checks Received:

Number of Dependants: (Legal) (Claimed)

Memberships:

KKK	NRA	Moose
PTL Club	VFW	Bass Club
		United Sons/Daughters of the Confederacy

Length of Right Leg Length of Left 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 pick up?

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   Scabies   Trench Mouth   Runny Nose   Bad Breath

Do you know any words that have more than 4 letters?

Have you EVER had more than one bath in a week?

If there is no menu on the left side of the screen, you need to click here to activate the menu.