AMERICAN NATIONAL ACTION PARTY


MEMBERSHIP APPLICATION


Name____________________________________, Age____Date of Birth______
                   First   Middle   Last


Height_________Weight________Hair Color______Eye color_____Sex M__F__


Address______________________________________________________________
P.O. Box or Street


City_________________________________, State_________, Zip Cod___________


Telephone No.(____)___________________________S.S.No.(____)(___)(_____)

E-Mail address________________________________

Education/ High school- Yes_____No_______Year graduated__________

College- Yes_____No______years completed__________year graduated_______

Occupation____________________________Skills___________________________

Military service-Yes__No__MOS_______Branch-Army__Navy__Air force__Other__

Married___Single___

Signature____________________________Date___________

Please enclose $25 application fee. Yearly dues are $60 that is only $5 a month

Those of Non-European ancestry need not apply.

Substance abusers need not apply.

Print and Mail to ANAP P.O. Box 243 Wellington, Nevada 89444