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 Smelly Feet( ) Toe Jam( ) Bad Breath( ) Tit Munge( ) apply) 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)________________________________