White Revolution Membership Application

In order to join you need to complete and mail in the following application along with your first month's dues ($10.00).

Send application to: WHITE REVOLUTION, Post Office Box 2024, Russellville, AR. 72811

I am a heterosexual, non-drug using, racially-conscious White person of wholly European ancestry, and I want to do my part to create a stronger, more active pro-White movement in order to help secure the existence of our people and a future for White children.  I am willing to work with members of other pro-White organizations for the common good of our race. I will pay the monthly dues I have indicated below. I am enclosing my first month's dues of a minimum of $10.00 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:  $____________

 Are you interested in attending pro-White demonstrations, rallies, protests, or concerts and other racial events?   (  ) Yes (  ) No

If you are currently involved with or a member of another pro-White organization please tell us the name to aid our coalition-building efforts:

Organization Name____________________________________________________

Please tell us about any particular skills, talents, or personal situations you have that might be of benefit to our efforts?

________________________________________________________________________

________________________________________________________________________

Name______________________________________________________

Street____________________________________________________

City________________________ State____________ Zip________

Date of Birth____________ Sex______ Marital Status________

Occupation____________________________________________

Telephone_______________________ E-mail address (Optional): ___________________

Please add other comments or information that you think we should know about below:

________________________________________________________________________

________________________________________________________________________

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