G'Day Mate MkII

Name: Last:_________________First____________ M.I.:___ Age:_____

Address:___________________________ County:_____________________

Religion:_______________ # of attendances in the last year______

Parent:Father's Name__________#of marriages____# of affairs_____

Mother's Name__________#of marriages____# of affairs_____

Address:_________________________________________________

________________________________________________________________

1. Do you own or drive a van? (If so, please discontinue
filling out form)______________________

2. In 50 words or less, describe what NO!!! means to you?______
____________________________________________________________

3. In 50 words or less, describe what LATE means to you?_______
____________________________________________________________

4. Where would you least like to be shot?______________________

5. Which is the last bone you want broken?_____________________

6. What do you want to be IF you grow up?______________________

7. The place for a woman is____________________________________

8. What is my daughter's name__________________________________

9. Who besides God should you fear the most?___________________

10. Is there a history of insanity in your family?______________

11. Have you or any member of your family ever spent time in
jail?_______________________________________________________

12. Are your parents closer relatives to each other than first
cousins?____________________________________________________

________________________________________________________________

Parent's Use Only