Legal Name: Last:_____________________ First: ____________________ Middle Initial: ______
Alias Used (if any): ____________________________________________
Mailing Address: _________________________________ City: ______________________________ State:_______ Zip Code:__________ Telephone Number: _______________________
Email Address: ____________________________ Marital Status: _____________________
Spouse’s Name:_____________________ Ethnicity/National Origin:__________________________
Date of Birth: / / Sex: Male / Female Height: ______ Weight: ________
Eye Color: _________ Hair Color: ________
Veteran: Yes / No Branch: ____________________________________
Dates - From: __________________________ To: ______________________________
Military Training/Skills (please specify):__________________________________________________ ___________________________________________________________________________________
Discharge: Honorable / Dishonorable
Level of Highest Education: ____________________________________________________________
Criminal Record: Yes / No Felony: Yes / No Misdemeanor: Yes / No
If yes on criminal charges, (please specify): _______________________________________________
Desired Commitment (check one): ___ NSM General Party $20.00 month
___ Supporter $20.00 month
As an Aryan Citizen of the United States of America or ________________________, I support a strong free Republic without Jewish influence or control. I recognize the National Socialist Movement, in its efforts to improve the environment and living conditions for all Aryan people. I agree with the goals and principles of the NSM and its aims therein to promote White European values. As a Member of the NSM, I promise to support the NSM and do my part to advance the movement and our race. I will actively fight for the NSM’s goals and initiatives by my contributions of money donations, materials, service, and skills. I, ___________________________________, support the goals of the National Socialist Movement for all White European nations. I pledge not to use any methods that are illegal, in the normal sense of the criminal statute, to attain the goals of the NSM and/or a strong free nation-state. I make this pledge to the NSM, of my own free will, for all White peoples to advance my race. I swear that I am not an agent or partisan whatsoever whose ideals are hostile to the NSM.
Signature: _____________________________________ Date: ___________________
ALL applicants MUST enclose 1 photograph of themselves and $30.00 application fee.
The monetary submission includes the first month’s donations. Subsequent monthly donations are $20 per month.
The NSM accepts money orders in US funds only (NO PERSONAL CHECKS). Well-concealed cash also acceptable.
The $30 dollar application fee helps cover NSM publications and handbooks for new recruits.
DISCLAIMER: The NSM first and foremost is a legal White civil rights organization. All information obtained via the NSM Application is used for the solitary purpose of membership determination. The decision to grant or deny said application is based solely on the information collected. It is never used for any other purpose.
OUR RACE IS OUR NATION!
NSM APPLICATION, REV. ED. 12/08/2018