First name:___________________
Last name(if known):_______________________
Address (where you live):
Mother's name (list also relation, i.e., sister):__________________
Birthdate(yours):____________________
Father's name (if known, if not, list two possible choices)______________
Color of neck:
Light Red( )
Medium Red( )
Dark Red( )
No Neck( )
Year of pickup truck:____________
Do you have the following in your truck:
Fuzzy Dice( )
Gun Rack( )
Coon Tail( )
Filled ash tray( )
Used Condoms( )
Dead Road Kill( )
Dog of Unknown Breed( )
Have you ever been to a large city? (Like Little Rock)
Yes( )
No( )
How far can you throw cow pies?__________
Do you eat cow pies? Yes( ) No( )
Wife's name:__________________
Is she:
Cousin( )
Neighbor( )
Sister( )
Mother( )
Neighbor's dog( )
Right hand( )
Does your wife weigh:
Less than 200 Pounds( )
Less than 300 Pounds( )
Less than a 747( )
More than a 747( )
Do you know what a 747 is?
Yes( )
No( )
How much smarter than you is your wife:
50 IQ Points( )
75 IQ Points( )
100 IQ Points( )
She Won't Tell Me( )
Does your wife wear:
A Dress( )
Pants( )
Hot Pants( )
Your Pants( )
Them Lawyer Clothes( )
Nothing( )
Nothing but an Arkansas U Hog Head Hat( )
Color of wife's hair:
Blonde( )
Red( )
Brown( )
Black( )
Bald( )
Did you understand the previous questions:
Yes( )
No( )
What does "previous" mean?
( )
Huh?( )
All of the Above( )
Have you ever had:
Herpes( )
Jock Rot( )
The Drip( )
Roids( )
Zits( )
Check all that apply:
Smelly Feet( )
Toe Jam( )
Bad Breath( )
Tit Munge( )
Ear Wax( )
Long Nasal Hairs( )
Brown Nose( )
Have you ever:
Castrated a Pig( )
Been Castrated by a Pig( )
Danced to Achey Breaky Heart( )
Had an Achey Breaky Heart( )
Been Mistaken for Elvis( )
Had Fantasies about Toto( )
Had Fantasies about Dorothy and Toto( )
Had Fantasies about Gilligan( )
Had Fantasies about Gilligan and the Skipper Too( )
Inhaled( )
Where was your last Elvis sighting?________________
On what date?___________
Can you count past five:
Yes( )
No( )
Past ten:
Yes( )
No( )
Explain in ten words or less why on Earth you want to be Governor of Arkansas:
Signature (or 'X' if you can't write)________________________________