Nationalist Coalition
Basic Application for Membership

ELIGIBILITY STATEMENT:
I am a White person of good moral character*, of entirely European descent, and at least 18 years of age. I believe in the Nationalist Coalition’s plan of working to create a better world through racial integrity, racial progress, self-determination, and freedom; and I will support the efforts of the Nationalist Coalition by paying my dues and by volunteering my efforts as indicated below to reach other White people with our message. I agree not to suggest or engage in any illegal act.
Furthermore I will not engage in giving any statements or interviews to any media outlet without prior written approval from an officer of the Nationalist Coalition.

Applicant's signature:___________________ Date:___________

SELECTION OF MONTHLY DUES LEVEL:
Please indicate the amount of your monthly donation, as high as your means permit. The monthly minimum is $10. A member may elect to pay monthly or for as many months in advance as desired, e.g., on a quarterly basis. IMPORTANT:

Amount of monthly dues: _______, times number of months paid in advance = TOTAL There is no application fee.

TOTAL enclosed: $_______

PERSONAL INFORMATION:

Name: (first)______________ (middle)_________ (last)_____________

Address:_______________________________________________

(city)______________________

(state/province)_________________ (zip or postal code)__________________

Date of Birth: (month/day/year)___________________

Sex: Male / Female

Telephone:___________________________

Email address:_________________________

Mail completed application (must include check, well concealed cash, or money order) made out to the Nationalist Coalition at the following address:

Nationalist Coalition
P.O. Box 7732
St. Petersburg, FL 33734

* Persons of Jewish descent, homosexuals or bisexuals, criminals, persons with a non-White spouse or sexual partner, or persons with more than an undetectable trace of non-White ancestry are explicitly barred from membership.