PART A. GENERAL INFORMATION

Name_________________________

Address________________________, (Wisconsin)

CB Handle______________________

Neck Shade:______Light Red _______Medium Red ______Dark Red

Number Of Teeth Exposed Full Grin: (Neither can exceed 3):

__________Upper _________ Lower

Mobile Home Color:

_________Two-Tone, Brown and White

_________Two-Tone, Pink and White

_________Faded Green and Gold

Model Of Pickup Truck:__________ Size Of Tires_________

Length of Right Leg________ Length Of Left Leg_________

PART B. COMPLETION

Note: To be accepted, you must be honest and be able to

check at least 20 items from questions below. Note that

good Packer fans can sometimes check many answers for some

questions.

1) My favorite music is:

____Country ____Western ____Anything played on an accordion

2) My favorite meal is:

_____ Head cheese and Old Milwaukee

_____ Cheese curd and Old Milwaukee

_____ Venison sausage and Old Milwaukee

_____ Kielbasa and carp (Surf & Turf)

_____ $5.99 Fish fry on Fridays

_____ 7 courses: brat and 6-pack

_____ Pickled eggs and turkey gizzards

3) Preferred Weapons:

_______ 12 Gauge

_______ Tire Iron

_______ Forehead

_______ Chain Saw

_______ Ice Auger

_______ Fishing Pole

_______ Empty Bottle

4) Primary Auto:

_________ '67 Ford Galaxy

_________ '67 Ford Galaxy with Transmission

_________ '73 Chevy Impala

_________ '67 Galaxy with '73 Impala Engine

_________ '67 Olds Delta 88

_________ '64 Chevy Belaire Station Wagon

5) I usually greet people by saying:

______ "Ya hey dere"

______ "Dem Packers is playing like a bunch of old women"

______ "Waddaya think a dem dere Packers"

______ "Dey should take da whole bunch a dem Madison

Liberals and just line em up and shoot em"

______ "Ya, dat Lombardi is God"

6) I can count to:

____10 ____20 ___20 if I take my boots off

7) I am:

____Married ____Happy ____Waiting for Packer Season Tickets

8) My favorite reading material is:

________ Fishing Facts

________ Beer Bottle Labels

________ Guns And Ammo

________ Today's Mercenary

________ Polka Digest

________ Sausage Making

9) Things I have in my front yard:

________ Various kitchen appliances

________ Cars on blocks

________ Transmissions

________ Pink flamingos

________ Deer hanging from tree (in-season)

________ Bird bath

________ Deer hanging from tree (out-of-season)

10) I mostly wear:

_______ Polyester pants and leisure suit jacket

_______ Polyester pants with holes and hooded sweatshirt

_______ Green Bay belt buckle

_______ Blaze orange jacket

11) The most memorable event I ever attended:

______ Minocqua Moose Call Competition

______ Tomahawk Crew Cut Championships

______ Oktoberfest in LaCrosse

______ Evinrude Outboard Motor Finals

______ Salmon-A-Rama

______ Free Sample Day At Pick-n-Save

12) My favorite entertainment is:

______ Deer hunting while drinking

______ Watching Green Acres reruns and drinking

______ Snowmobiling while drinking

______ Drinking and burping

______ Drinking and Canasta

______ Drinking and Pinochle

13) Pick One:

________ Someone is helping me read this

________ Someone is reading this to me