Box 20, Folder 2, Document 62

Box 20, Folder 2, Document 62

N.A.A.C.P. MEMBERSHIP





APPLICATION
NAME 2 oa DATE
ADDRESS ae —
N MOBILE, GIVE MAKB,MODEL & # TAG
NAME OF MOTHER... ... NAME OF FATHER



Baud 5 : nown
MAKE OF AUTOMOBILE OWNED (CHECK ONE) Ns OF CHILDREN CLAIMED FOR RELIEF:
LINCOI







CADILLAC ~~ : EG E) IF
MARITAL STATUS (CHECK ONE)
SHACKED UP | -_
MAKING our rertin TOTAL -W. OF CHILDREN FATHERED IF
WORN OUT ~~. : !
COMMON LAW ~~
a ee eae aue ROM THEFT — 4
H ITAL F
FREE PUBLIC HEALTH ~~ FROM RELIEF i
FROM UNEMPLO
LIST WHITE SCHOOL YOU WOULD LIKE IF YOU HAVE ANY OTHER SOURCE OF —
TO ATTEND CAN INCOME EXPLAIN
YOU GIVE ANY OF THESE FOR REFER_ "
ERENCES:
ABILITIES: ANITA LOOS EARL WARREN
SLUM CONSTRUCTION ED SULLIVAN JOHN KASPER
GOVERNMENT EMPLOYEE RICHARD NIXON RALPH McGILL
AGITATOR 9 MARLON BRANDON ROBERT KENNEDY
GOOD PREACHER
DANCING
DOPE ADDICT
HAVE RAZOR WILL TRAVEL (YES OR NO)

WOULD YOU BE WILLING TO SERVE ON THE FOLLOWING:

DIRECTOR OF THE FORD FOUNDATION

DIRECTOR OF URBAN LEAGUE

UNITED NATIONS (STEVENSON ATD)
ARE YOU NOW, OR HAVE YOU EVER, BEEN ASSOCIATED WITH ANY ORGANIZATION
THAT BELIEVES IN: PREVENTING SOCIAL LIBERTY AND DEMOCRACY BY THE USE
OF FORCE IF NECESSARY:

PLEDGE:

I BELIEVE IN EQUALITY,THYAT NIGGERS IS BETTER THAN WHITE FOLKS IS,
AND THAT THE WHITE FOLKS SHOULD PAY MORE AND MORE TAXES AND US NIGGERS
SHOULD HAVE MORE WELFARE AND NOW THAT WE HAS THE SUPREME COURT AND THE
U.S. ARMY ON OUR SIDE, THE LAW SHOULD NOT B= CHANGED ANY MORE. I PRO-~
MISE TO PRAISE McGILL AND THE SUPREME COURT AND NOT TO SNICKER WHEN
ANY OTHER DISTURBED WHITE FOLKS STARTS CRYING OVER HOW WE IS BEING PER-
SECUTED. I KNOW MY RIGHTS AND THIS PROMISE DOES NOT TAKE AWAY MY
RIGHTS TO GET RELIEF, DODGE TRAFFIC WARRANTS OR BREAK MY PROMISE WHEN

I HAS TO.
SIGNED (MAKE X IF YOU CANNOT WRITB)