National Socialist Movement

SUPPORTERS APPLICATION

Name _______________________________________________________________________

Address _____________________________________________________________________

City _________________________________ State ________ Zip Code _________________

Country (if other than U.S.) ______________________________________________________

Telephone Number (_______) ____________ - ___________

E-Mail Address _______________________________________________________________

Are you now or have you ever been a member of the NSM? o Yes o No

MEMBERSHIP LEVEL SELECTION

o Brown shirt - $20.00 entitles supporter to certificate and one year subscription to NSM magazine.

o Black shirt – $60.00 entitles supporter to certificate, one year subscription to NSM Magazine, Bulletin and NSM T-Shirt.

o Silver shirt - $100.00 all entitlements as Black Shirt PLUS NSM ARMBAND.

o Gold Shirt - $250.00 or more all entitlements of Silver Shirt. PLUS $50.00 certificate toward ANY NSM merchandise.

SUPPORTER GUIDELINES

1. Supporter donations are nonrefundable.
2. Supporter status is non-transferable.

3. Supporters agree to focus on improving the professional knowledge and expertise of

critical areas of the Party through an education-oriented rather than activist approach.

4. Supporters agree to promote services and products of the National Socialist Movement.

PAYMENT INFORMATION

To Submit Form: Complete and return with payment. Check or Money Order must be made payable in US dollars drawn on a US Bank. Make check or money order payable to NATIONAL SOCIALIST MOVEMENT. Returned checks will be electronically re-deposited along with a return fee of $30.00, plus an additional $16 fee to cover NSF check charges to NSM. (or as allowed by state law).

To pay by credit card complete below:

Credit Card: o Visa o Master card o Discover

Card # __________________________________________________________________________

Expiration Date _____________ /______________

CVC Code ___________ (this is the extra 3 digit security number on the back of your card on the signature line)

Signature ________________________________________________________

I authorize the NSM to complete two payments of $______ on the below listed dates to complete my Supporter status request.

Date: Day/Month/Year__________________________Day/Month/Year____________________

Send completed membership form, check or money order / credit card payment to:

Supporter

National Socialist Movement

P.O. Box 13768

Detroit, MI. 4821

Phone: (651) 659-6307

By completing this Supporter application, I certify that I am seeking to become a supporter of NSM and that I agree to abide by the principles of the National Socialist Movement.

________________________________________________________

Signature

__________________________________

Date