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Any and all information
given must be true and exact. Any discrepancies or false information will
result in rejection of
application.ALL APPLICANTS ARE SUBJECT TO A POLYGRAPH TEST AND RANDOM DRUG
TESTING
1.
Name:___________________________________________________________________________
2.
Address:_________________________________________________________________________
3. Phone include area code:_____________________ 4. Date of
Birth:___________________________
5. Place of
employment:_______________________________________________________________
6. School (Years completed)____________________ 7.
Occupation:____________________________
8: Military / Experience:________________________ 9. National
decent:_________________________
10. Marital status:____________________________ 11. Name and decent of
spouse:_______________
12. Physical condition:_________________________ Explain if you are
handicapped:________________
__________________________________________________________________________________
13. Do you have a high school diploma or GED?_____________
College?_________________________
14. Age:______ Height:_______ Weight:_________ Color hair:____________
15. Are you registered to vote? ___________________ S.S.N.__________________
16. Previous political activity:____________________________ Have you ever
been convicted of a felony?
if so please explain and tell us where the conviction took
place:_________________________________
___________________________________________________________________________________
17. Any legal charges pending against
you?___________________________________________________
if so
explain:_______________________________________________________________________
18. Why do you want to become a Klan
member?_____________________________________________
___________________________________________________________________________________
19. Have you ever worked for a law enforcement
agency?_______________________________________
if so, where and how
long:____________________________________________________________
Are you still employed by that agency or any other law enforcement agency
now?___________________
___________________________________________________________________________________
20: Through what means were you able to contact the KKK?_____________________________________
___________________________________________________________________________________
List three (3) personal references on the back (application will remain
discrete)
DECLARATION: I AM OF THE WHITE ARYAN RACE. I UNDERSTAND THAT THE MISSISSIPPI
WHITE KNIGHTS ARE
AND ORGANIZATION COMPROMISED OF ARYANS OF ANGLO-SAXON, GERMANIC, NORDIC,
BASQUE, LOMBARD,
CELTIC, AND SLAVIC BACKGROUND. I FURTHER UNDERSTAND AND AGREE WITH THE
MISSISSIPPI WHITE
KNIGHTS EXCLUSION OF JEWS, NEGROES, MEXICANS, ORIENTALS, AND MONGRELS.
PLEDGE: I WILL DISTRIBUTE M.W.K. LITERATURE IN MY AREA TO AWAKEN OUR PEOPLE
TO GOD'S LAW. I
CERTIFY THAT I WILL DO SO IN A MANNER THAT IS RESPECTFUL AND PROFESSIONAL.
A $50.OO NON-REFUNDABLE FEE MUST ACCOMPANY THIS APPLICATION TO BE PROCESSED.
NOW OFFERING LIFETIME MEMBERSHIPS 1000,00, DUES ARE 10.00 MONTHLY OR 100.00
ANNUALLY
I HEREBY SWEAR UNDER OATH AND PENALTY OF PERJURY THAT THE ABOVE INFORMATION
IS TRUE TO THE
BEST OF MY KNOWLEDGE.
SIGNATURE:____________________________________________ APPROVED
BY:____________
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