Friday, March 19

Geez...You know I had too...


First Name________________

Last Name:

( ) Atcitty

( ) Begay

( ) Begaye

( ) Benally

( ) Nez

( ) Yazzie

Age:____(if unsure, guess)

Sex:____M______F_______Not sure

Shoe Size:______Left______Right

Tribal Clothing Jacket Size:________


( )Spring Sheepherder

( )Summer Sheepherder

( )Fall Sheepherder

( )Winter Sheepherder

( )Unemployed

( )Dirty politician

Spouse's Name:________________

2nd Spouse's Name:______________

3rd Spouse's Name:____________

Relationship with spouse:

( )Best friend's wife

( )Best friend's sister

( )Don't remember

( )It just happened

( )Which one....

Lover's Name:___________

2nd Lover's Name:___________

Number of children living in household:_____

Number of children living in shed:________

Number of children that are yours:_________

Mother's Name:________

Father's Name:_________

(if not sure, leave blank)

Education:1st; 2nd; 3rd; 4th (Circle highest

grade completed)

Do you ( )own or ( )rent your mobile home? (Check

appropriate box)

___Total number of vehicles you own

___Number of vehicles that still crank

___Number of vehicles in front yard

___Number of vehicles in back yard

___Number of vehicles on cement blocks

___Number of vehicles with a water tank

Firearms you own and where you keep them:






Model and year of your pick-up:___________ 194_

Do you have a gun rack?

( )Yes ( ) NO; If no, please explain:

Newspapers/magazines you subscribe to:

( ) Navajo Times

( ) Gallup Independent

( ) Navajo/Hopi Observer

( ) Buckle Bunnies

( ) NFR

___Number of times you've seen a Navajo Nation


___Number of times you've seen a NN president with a


___Number of times you've seen a NN president with

numerous women

How often do you bathe:

(if no running water, you may still respond)

( )Weekly

( )Monthly

( )Not Applicable

Color of teeth:

( )Yellow

( )Brownish-yellow

( )Brown

( )Black

( )N/A

Brand of alcohol you prefer:

( )T-Bird

( ) G-D

How far is your home form a paved road?

( )1 mile

( )2 miles

( )don't know

No comments: