National Socialist Movement
National Headquarters
PO Box 13768
Detroit, MI 48213

Legal Name: Last:_____________________________ First__________________________________Middle Initial _______

Alias Used ________________________________________________________________________________________________

Mailing Address:_______________________________City:_____________________State:____________________Zip Code:_______

Telephone Number: ________________________Email Address: __________________________________________________

Marital Status: ____________________Spouse’s Name:________________________

Ethnicity/National Origin:_________________________________________________________________________________

Date of Birth:       /       /         Sex: Male ~ Female ~ 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 Highest Education:_______________________________________________________________________________

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

If yes on criminal charges, (please specify): ____________________________________________________________________


Level of Desired Commitment (circle all that apply):

Active Membership ~ Supportive~Financial Role / Indicate Branch: NSM ($20.00/month) ~ NSM StormTrooper $20.00/month ) ~ NSM Woman’s Division ($20.00/month) ~

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 donations, 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:___________________

ALL applicants MUST enclose (2) pictures of themselves and $30.00 application fee, which includes first month’s donations. Subsequent monthly donations are $20 per month. The National Socialist Movement accepts money orders or cashier’s checks in US Funds only, No cash please. The $30 dollar application fee is to help cover NSM publication/handbooks to new recruits.
Disclaimer: The NSM first and foremost is a legal White civil rights organization. And 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.