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- APPLICATION TO LIVE IN WEST VIRGINIA
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- Name: ________________ Nickname: ______________ CB Handle: ___________
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- Address (RFD No.): _____________________________________________________
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- Daddy (If unknown, attach list of 3 suspects): _________________________
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- Mamma: ______________ Neck Shade ( ) Light Red ( ) Medium Red ( ) Dark Red
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- Number of teeth exposed in full grin: Upper ___________ Lower _________
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- Name of Pickup Truck Owned: ___________________ Height of Truck: ________
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- Truck equipped with:
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- ( ) 8 - Track ( ) Load of Wood ( ) Hijacker shocks ( ) Mud-Grip Tires
- ( ) Fuzz Buster ( ) Mag Wheels ( ) Dual CB Antennas ( ) Racoon Hide
- ( ) Spittoon ( ) Camper Top ( ) Air Horns ( ) Big Dog
- ( ) Mud Flaps
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- Number of empty beer cans on floorboard of pickup: ______________________
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- Bumper Stickers: ( ) Eat More Possum ( ) Peanut Butter
- ( ) Honk If You Love Jesus ( ) Wave If You're Horney
- ( ) Redman Chewing Tobacco
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- Define the Following (must be 90 percent correct):
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- 1. Gritts 6. Muscadine 11. Cobbler 16. Tater
- 2. Goobers 7. Brogans 12. Fatback 17. Pig Skins
- 3. Collards 8. Redeye Gravy 13. Tote 18. Pinto Beans
- 4. Sidemeat 9. Sawmill Gravy 14. Poke 19. Turnip Salit
- 5. Chitlins 10. Soppin Syrup 15. Cracker 20. Well Water
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- Favorite Vocalist:
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- ( ) Box Car Willie ( ) Conway Twitty ( ) Loretta Lynn ( ) Donna Fargo
- ( ) Elvis ( ) Johnny Cash ( ) Tammy Wynette ( ) George Jones
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- Favorite Recreation:
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- ( ) Square Dancin' ( ) Possum Huntin' ( ) Skinny Dippin' ( ) Craw Daddin'
- ( ) Gospel Singin' ( ) 4 - Wheelin' ( ) Drankin' ( ) Spittin' Backy
- ( ) Blue Grass Conventions ( ) Bull Chip Throwin'
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- Weapons Owned:
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- ( ) Deer Rifle ( ) Bird Gun ( ) Varmit Rifle ( ) Log Chain
- ( ) Chain Saw ( ) Tire Iron ( ) Pick Handle ( ) Sawed-off Shotgun
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- Number of Hound Dogs: _______ Type: ( ) Blue Tick ( ) Black & Tan ( ) Beagle
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- Cap Emblem: ( ) John Deere ( ) CAT ( ) McCollough Chain Saws
- ( ) Budweiser ( ) NAPA ( ) Coors
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- Number of Weeks Unemployed: ______ Number of Welfare Checks Recieved: _____
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- Number of Dependents: (Legal) ___________ (Claimed) _____________
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- Memberships: ( ) NRA ( ) Moose ( ) PTL Club ( ) VFW
- ( ) Bass Club ( ) United Sons/Daughters of the Confederacy
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- Length of Right Leg: ________________ Length of Left Leg: ______________
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- Does your truck contain some part painted the
- official state color, Primer Red? _________________
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- How many cars do you have jacked up on blocks in your front yard? _________
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- How many kitchen appliances (working or not) will you keep
- on your front porch? ______________
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- Will you be a part of the West Virginia Intelligentsia
- with a measurable IQ? ________________
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- Do you wear mostly double knit polyester pants with snags? _____________
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- Do you own any shoes, if so, how many? _______
- What year did you last purchase shoes? ________
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- Are you married to any of the folling:
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- Sister _______ Cousin ________ Sow __________ Do you know her name? _____
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- Does your wife weigh more than your pickup? _________
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- Does your wife weigh more than your pickup? _________
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- Can you sign your name and get the spelling right every time? _____________
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- Have you ever stayed sober for a whole weekend? _______________
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- Can you count: Past 10 with your shoes on? _________________
- to 21 with your fly up? _________________
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- Medical Information:
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- Do you have at least 2 of the following: BO __________ Crabs ___________
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- Head Lice ________ Scabies ________ Trench Mouth ___________
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- Runny Nose __________ Bad Breath ________
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- Do you know of any words that have more than 4 letters? ___________
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- Have you EVER had more than one bath a week? ______________
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