Imperial Klans of America
I (print name):_________________________ hereby apply for membership in the I.K.A.
Street address: _________________________________________
Date of Birth______(must be 18):__Sex (M / F )
Phone or Cell:(____)-_______-___________Marital status:____________________________________
Military Experience: _______________________________________________________
National Descent: __________________________________
Name of Wife or Girlfriend [Must be White]: ________________________________________________
Height: _______ Weight: _______ Hair Color:_____________ Eye color:_______________
Do you have transportation?__________________________________
Have you ever been convicted of a Felony? _____ If yes give details___________________________
Organizations you belong to: ________________________________________________________
Why do you want to become a member of the
Physical Conditions (List any Disabilities):_______________________________________________
Any Legal Charges pending against you now? _____
if yes give details:
What talents do you have that would help the IKA?:____________________________________________
Do you now work for or have you ever worked
for any Law Enforcment Agency?
Have you Previously applied to the Klan?
explain & give dates:
Give your e-mail address here: _________________________________________________________
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 $25.00)_________($50.00)___________(75.00)_________ If you feel you would like to make a greater donation it would be appreciated to further our cause for our race.
Please include a current photo of yourself, along with $40.00 for US Membership. $45.00 (American Currency Only) outside
the U.S. -- Donations for membership. Thank You.
Postal Money Orders or Cash. No Checks!!!!!!!!!!!!!!!!!
Print this application and enclose it with your donation and photo and mail to:
P.O. Box 177
Dawson Springs, KY 42408 USA
I do swear and verify that I am of the White
I am not or have never been a follower of the Jewish religion.
I am not under bond or indictment for any criminal acts.
I have never engaged in an inter-racial relationship.
I will stand by my brothers and my race.
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.
Sign and Date:______________________________________
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