Application for membership

NATIONAL ALLIANCE * POST OFFICE BOX 90 HILLSBORO * WV 24946


   I am a  White person  of good moral  character, with no 
ineligibility.  I am in agreement  with the  goals and the 
program of the  National Alliance  outlined above,   and I
want to  participate in the  Alliance's  effort to build a
secure and healthy future for my race by becoming a member.
I will pay the monthly  dues I have indicated below.  I am 
enclosing my first month's dues and my $15 application  fee
with this application.

Signature of Applicant:______________________ Date:_______


CHOICE OF MONTHLY DUES LEVEL:
The applicant should indicate his  dues level in the space
below,  choosing a  whole-dollar value  (minimum:  $10 per
month) as high as his means permit.  A member may elect to 
pay his dues each month or as many months in advance as he
wishes (e.g., on a quarterly basis).

Amount of monthly dues:___________________________________

May we give your name and address/telephone to a trusted
member in your area?  [ ] Yes      [ ] No

Were you contacted or given information about the National
Alliance by a member? [ ] Yes      [ ] No    If "yes" what
is the member's name? ____________________________  If "no"
how did you learn about the National Alliance? ___________
__________________________________________________________

Name______________________________________________________
Street____________________________________________________
City________________________ State____________ Zip________
Date of Birth____________ Sex______ Marital Status________
Occupation________________________________________________
Telephone_________________________________________________

From www.natallmd.com

E-mail address (Optional):________________________________