Application To Live In Maine
(Flatlanders Need Not Apply)


Name:________________________________

Nickname:_____________________________C.B.Handle___________________

Address (R.F.D.  - HCR)______________________________________________

Daddy (If unknown, attach list of three suspect(s):_________________________

Mama:_____________________________________

Neck Shade:  [    ]  Light Red    [    ]  Medium Red    [    ]  Dark Red

Number of Teeth Exposed in Full Grin:  ______  Upper:  ______  Lower:  ______

Make of Pickup Owned:_______________________ Size of Tires:___________

Number of Empty Beer Cans on Floor of Pickup:_______________

Truck Equipped with:

[    ]  Gun Rack            [    ]  Mud Flaps            [    ]  Camper Top          [    ]  Air Horn
[    ]  8-Track                [    ]  4-Wheel Drive       [    ]  American Flag      [    ]  Rust
[    ]  Fuzz Buster         [    ]  Load of Wood       [    ]  Hijack Shocks      [    ]  Mud Tires
[    ]  Spittoon               [    ]  Running Boards    [    ]C.B. Antennas        [    ]  Roll Bar

Bumper Stickers:

[     ]  Wave if Your Horny                    [     ]  I Dig Clams
[     ]  Almost Heaven, Bucksport         [     ]  I Snatch Kisses and Vise Versa
[     ]  Where the Hell is Orrington?       [     ]  Maine-iac
[     ]  Honk if You Love Jesus              [     ]  Redman Chewing Tobacco
[     ]  Wood is Wonderful                     [     ]  I Ain't No Flatlander!
[     ]  Olde Fart                                   [     ]  Save the Black Fly
[     ]  All you ecological bastards can freeze to death in the dark!

Favorite Beverage:

[     ]  Genesee[     ]  Nastyganset[     ]  Labatt     [     ]  Molson
[     ]  Moosehead    [     ]  Bangor Tap Water[     ]  Budweiser

Favorite Vocalist:

[     ]  Elvis[     ]  Conway Twitty    [     ]  Loretta Lynn
[     ]  Slim Whittman        [     ]  Johnny Cash      [     ]  Willie Nelson
[     ]  Dick Curlis              [     ]  George Jones    [     ]  Bert & I

Favorite Recreation:

[     ]  Square Dancin       [     ]  Coon Hunting                    [     ] Fishing with LIVE BAIT
[     ]  Drankin         [     ]  Drankin                             [     ]  Drankin
[     ]  Blue Grass Fest    [     ]  Jackin                               [     ]  Get'n Drunk

Favorite Weapon:

[     ]  Tire Iron               [     ]  Pick Handle  [     ]  Log Chain         [     ]  .22

Number of Hounds:  _________ Type:  [     ]  Blue Tick   [     ]  Beagle  [     ]  Black & Tan

Cap Emblem:

[     ]  John Deere       [     ]  Stihl         [     ]  Foggy Mt.              [     ]  CAT
[     ]  Sugar Loaf        [     ]  Eat Me     [     ]  Skoal                    [     ]  Budweiser

Memberships:

[     ]  NRA              [     ]  VFW           [     ]  PTL Club           [     ]  Ducks Unlimited
[     ]  Fish & Game Club                      [     ]  KKK                 [     ]  Snow Warriors

Length of Right Leg:__________________ Length of Left Leg:______________

How many cars do you have up on blocks in your front yard?_______________

How many kitchen appliances will you keep on your front porch?____________
                                           (Working or Not)

When was your last Elvis sighting?_______________________

Do you wear mostly polyester pants with snags?____________________

Do you own any shoes (not counting boots), if so how many?________________

Are you married to any of the following?:
             [     ]  Sister            [     ]  Cousin     [     ]  Cousin's Sister     [     ]  Sow

Does your wife weigh more than your pickup?_________________

Can you sign your name and spell it right every time?________________

Have you ever stayed sober for a whole weekend?__________________

Can you count:         [     ]  Past 10 with your shoes on?
        [     ]  Past 21 with your fly up?

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

Medical Information:

Do you have at least 2 of the following:

[     ]  B.O.          [     ]  Crabs                 [     ]  Head Lice           [     ]  Bad Breath
[     ]  Scabies     [     ]  Yellow Teath       [     ]  Green Teath        [     ]  Runny Nose
[     ]  Tattoos      [     ]  Cross Eyed        [     ]  Stutter                [     ]  Fleas

Your signature   (One "X" will do):_________________________ Date:________