Legal Name: Last: ______________________  First  ___________________ Middle Initial  ____

 Alias Used ________________________ (Female Applicants) Maiden Name: __________________

 Mailing Address: __________________________________________________________________

 Telephone Number: ___________________   Email Address: ______________________________

 Marital Status: _______________________    Spouse’s Name: _____________________________

 Ethnicity/National Origin : ________________________________________________________

 Mother’s Maiden Name: _________________________________  Date of Birth:       /       /        

 Sex:   M   F    Height: ______    Weight: _______   Eye Color: _______    Hair Color: ___________  

 Veteran:  Yes   No   Branch: ___________________________   Rank: ________________________

 Discharge:   Honorable   Dishonorable     Dates:  From _________________ To __________________

 Military Training/Skills (please specify): _______________________________________________

 _______________________________________________________________________________

 Other Skills/Talents (please specify): __________________________________________________

 _______________________________________________________________________________

Level of Education: _______________________________________________________________

 Criminal Record:   Yes    No                       Felony: Yes   No                      Misdemeanor: Yes    No  

 Charges (please specify): __________________________________________________________

 _______________________________________________________________________________

Level of Desired Commitment (circle one):

Membership                      Supportive/Financial Role

 Indicate Branch (circle one):  NSM ($10.00/month)                           NSM Stormtrooper $10.00/month ) 

 NSM Woman’s Division ($10.00/month)                          Skinhead Division ($35.00/year, free NSM Patch)                                                  

 Viking Youth Corps (13-18 yeas old)                        Farmers’ Association                               Workers Union 

 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 their efforts to improve the environment and living conditions for all Aryan people. I am in agreement with the goals and principles of the NSM and their aims therein to promote White European values. As a Member of the NSM, I promise to support the NSM and do my part in an effort to advance the Movement and our Race, as a whole. I will actively fight for the National Socialist Movement’s goals and initiatives by my contributions of  money, 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:___________________

OUR RACE IS OUR NATION !

ALL applicants MUST enclose (2) 2x2 Passport photos and $20.00 application fee, which includes first month’s dues.
The National Socialist Movement accepts checks, money orders or cashier’s checks) No cash please.

Disclaimer:   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.