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Membership Application for The Patriot Network--Basic
Name_____________________________________________Phone______________________
Address______________________________________________________________________
City________________________________________________State________ZIP__________
Occupation________________________________
Email_______________________________
Phone at Work_____________________Cell
Phone___________________________________
Spouse's Occupation__________________________Phone at
Work______________________
Cell
Phone__________________________Email______________________________________
Special
Skills/Hobbies___________________________________________________________
Am Interested in working
part-time_____________________Full-time_____________________
How did you hear about our
organization?____________________________________________
Current Tax Procedural
problems__________________________________________________
Arrangements for
them__________________________________________________________
If now employed by a governmental agency, enter agency name, job title, and
duties
_____________________________________________________________________________
I do________I do not_______want to have my name and address in newsletter.
I freely donate to the organization for the good of the country
$__________________________
(All donations are non-refunadable)
I have listened to the presentation at the introductory meeting; I pledge a
good faith effort to participate and to support the programs and activities of
this private political association, its drive to RESTORE CONSTITUTIONAL
GOVERNMENT. I understand the local club is a member of the National Association
of Independent Patriot Clubs. I understand that all monies given to the club are
a donation to the Cause.
I want to help reach 1000 members in this area, for then the battle is
virtually won.
I agree not to engage in bickering, and back biting and I will follow
the Rule Against Factionalism.
I affirm that I support and defend the Constitution of the United
States of America, will defend and
protect the Republic for which it stands, against our enemies, foreign
and domestic.
Date________ Signature___________________________ Spouses Signature________________________
Fill out and mail with cash, check or money order (Leave payee line blank) to
Patriot Network 201B West Butler Rd, #379, Mauldin, SC 29662