Join the
IKA of The Ku Klux Klan

• I do swear and verify that I am of the White race.
• I am not addicted to or a user of illegal drugs.
• I am not or have never been a follower of the Jewish religion.
• I believe in the segregation of the races and I have never engaged in an inter-racial relationship.
• I believe in and will defend my Country, Homeland, and its Constitution and laws.
• I am not under bond or indictment for any criminal acts.
• I will conduct myself in an acceptable manner and WILL NOT commit criminal acts while a member of The IKA of the Ku Klux Klan.

I (printname,:_________________________ hereby apply for membership in The IKA of the Ku Klux Klan���.

Street address:__________________

City: ___________________________

State/Zip:__________________________

Date of Birth______(must be 18):__Sex (M / F )

Phone:(____)-____-____

Maritial staus____________

School(years completed)___________

Occupation:________________________

Place of Employment:___________________________

Military Experience:_____________________

National Descent:________________________

Name and Descent of Spouse:_________________________________

Physical Conditions (List any Disabilities):______ _________________________________________________

Height:___Weight:___Hair Color___Eye color____

Special Skills:_______________________________

Social Security number:_______________________

Are you registered to Vote?_______

Previous Political Activity___________________

Do you have personal Transportation?_______

Have you ever been Convicted of a Felony?_____If yes give details_____________ ______________

Any Legal Charges pending against you now_____ if yes give details______________ _______________

Family Situation:_____________________________

What Talents do you have which would be useful to the Klan?____________________ ____________________

Organizations you belong to_______________________ _________________________________________________

Why do you want to become a member of the Klan? _________________________________________________

Do you now work for or have you ever worked for any Law Enforcment Agency?_______________________

Will you consent to a Polygraph test?_________

Have you Previously applied to the Klan? if so explain & give dates_____________________________

List (3) Personal Refrences, Not including Immediate Family Members. Please give Names, Addresses, and Phone Numbers(application will remain discreet) ___________________________________________ ___________________________________________ ___________________________________________

Do you Know anyone interested in Joining?_____

How were you able to contact us?______________

Drivers License or State I.D.# :______________

Signature:_____________________________

*I would like to be a full member of the Imperial Klans of America of the Ku Klux Klan.(int.)____

*I can not be a full member at this time for personal reasons, but would like to show my support by donation.(int.)__ My donation (min $10)__

Dues are $35.00 per year and Extra Contributions are Greatly appreciated to further Our Cause.

Please include A LONG S.A.S.E.,A current Photo of yourself , along with $35 donation for membership. Thank You..

--Print this application and enclose your donation,Photo along with a SASE To: IKA * P.O. BOX 309 * Powderly,Ky 42367 USA