Join the
Imperial Klans of America

I (print name):_________________________ hereby apply for membership in the I.K.A.

Street address: _________________________________________

City: ___________________________________________________

State/Zip: _____________________________________________

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

Phone or Cell:(____)-_______-___________

Occupation:_____________________________________________________________

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 Klan? ______________________________________

__________________________________________________________________________________

__________________________________________________________________________________

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? if so 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:

IKA
P.O. Box 177
Dawson Springs, KY 42408 USA

I do swear and verify that I am of the White race.
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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