Join the
Imperial Klans of America

• I do swear and verify that I am of the White race.
• I am not addicted to or a user of illegal drugs.
• I am not or have never been a follower of the Jewish religion.
• I believe in the segregation of the races and I have never engaged in an inter-racial relationship.
• I believe in and will defend my Country, Homeland, and its Constitution and laws.
• I am not under bond or indictment for any criminal acts.
• I will conduct myself in an acceptable manner and WILL NOT commit criminal acts while a member of The IKA of the Ku Klux Klan.

I (printname,:_________________________ hereby apply for membership in The IKAKKKK†††.

Street address:__________________

City: ___________________________________________________

State/Zip:_____________________________________________

Date of Birth______(must be 18):__Sex (M / F )

Phone:(____)-_______-___________

Maritial staus____________________________________

School(years completed)___________

Occupation:_____________________________________________________________

Place of Employment:______________________________________________________

Military Experience:_______________________________________________________

National Descent:__________________________________

Name and Descent of Spouse:________________________________________________

Physical Conditions (List any Disabilities):______________________________________ ________________________________________________________________________

Height:_______ Weight:_______ Hair Color:_____________ Eye color:_______________

Special Skills:_____________________________________________________________

Are you registered to Vote?___________________

Previous Political Activity___________________________________________________

Do you have personal Transportation?_____________________

Have you ever been Convicted of a Felony?_____If yes give details_____________ ______________

Any Legal Charges pending against you now_____ if yes give details__________________________ _________________________________________________________________________________

Family Situation:____________________________________________________________________

What Talents do you have which would be useful to the Klan?________________________________ _________________________________________________________________________________

Organizations you belong to___________________________________________________________ _________________________________________________________________________________

Why do you want to become a member of the Klan? _________________________________________________________________________________

Do you now work for or have you ever worked for any Law Enforcment Agency?__________________________________________________________________________

Will you consent to a Polygraph test?___________________________________________________

Have you Previously applied to the Klan? if so explain & give dates_____________________________

List (3) Personal Refrences, Not including Immediate Family Members. Please give Names, Addresses, and Phone Numbers(application will remain discreet) ___________________________________________ __________________________________________________________________________________ _______________________________________________________________________________________

Do you Know anyone interested in Joining?_______________________________________________

How were you able to contact us?_______________________________________________________

Give your e-mail address here: _________________________________________________________

Drivers License or State I.D.# :___________________________________________________________

Signature:______________________________________

*I would like to be a full member of the Imperial Klans of America, Knights of the Ku Klux Klan.(int.)____

*I can not be a full member at this time for personal reasons, but would like to show my support by donation.(int.)__ My donation (min $20)_________($50)___________($100)__________($)____________

Dues are $40.00 inside the US and $45.00 outside the US. per year and Extra Contributions are Greatly appreciated to further Our Cause.

If you don't live in the US, please do what you can on this application for membership.

Please include A current Photo of yourself , along with $40.00 inside the US $45.00 outside the us. donation for membership. Thank You..

--Print this application and enclose your donation ,photo & mail To:
IKA
P.O. BOX 41532
Houston, TX 77241 USA