How long does it take you to walk down your driveway?   ___ hours   ___ minutes  What kind of driveway do you have?  ___ dirt   ___ gravel   ___ other  What kind of tractor do you own? _____ model   ______ year  How old is your septic tank?  ________  How do you get your household water?  __ pump   __ rain water   __ piped from town  How many dual relationships do you have? __________  How many NON-dual relationships do you have? __________ Do you have an accent?  ___ Yes   ___ No  Do you supplement your income by farming?   ___ Yes   ___ No  How far do you have to drive to get to work?  ______ miles  How many miles per week do you put on your car?  ______ miles How many mountains do you cross to get to work?  ______ (number) Have you ever been to New York City?  ___ Yes   ___ No  If you've been to New York City, were you scared?  ___ Yes   ___ No  What percentage of your clients have a transportation problems?  ____%
	If you want to be a member of the Rural Social Work Caucus, you don't have to answer these questions.  Some folks feel a need to complete a form in order to join a professional organization.  So you can keep the completed form.  No one at the main office wants it.
	To become a member of the Rural Social Work Caucus, click your heels together three times and say, "I want to be a member of the Rural Social Work Caucus, I want to be a member of the Rural Social Work Caucus, I want to be a member of the Rural Social Work Caucus."  Do this and you'll be a member.  There is no cost.
	If you want to get on the mailing list, subscribe to the Rural Social Work Caucus Listserv. Write to the listserv and ask who has the mailing list.  When she/he replies, give them your information.