HOTEP REGISTRATION + LITERACY EVALUATION

Hotep Registration Form
YOU MAY USE THIS FORM TO:
- NEWLY REGISTER AS AN OFFICIAL MEMBER OF THE HOTEP COMMUNITY.
- RECONSIDER THE FUNDAMENTAL ORIGINS OF YOUR HOTEP BELIEF SYSTEMS.
- CHANGE OR REAFFIRM YOUR NAME OR GENDER IDENTIFIER IN ACCORDANCE WITH PERSONAL AND/OR CULTURALLY UNDERSTOOD STANDARDS.
TO REGISTER YOU MUST:
- BE OF AFRICAN DESCENT OR OTHERWISE IDENTIFY AS A MEMBER OF THE BLACK DIASPORA.
- BE AT LEAST 16 YEARS OF AGE ON THE DATE IN WHICH THE FORM IS COMPLETED.
- COMPLETE THE ATTACHED HOTEP LITERACY EVALUATION WITH A SCORE OF AT LEAST 20 PERCENT (THREE CORRECT ANSWERS).
1a. Reason (Check All Boxes That Apply)*

New Hotep RegistrationName or Identifier ChangeChange Of Residence
1b. Do you identify as Black?*

YesNo
1c. Are you an advocate for Black liberation?*

YesNo
If you checked “No” to either of the questions in section 1, do not complete this form.
Email:*
example@example.com
Slave Name

First NameLast Name
Chosen Name (If same, leave blank)

First NameLast Name
Date of Birth

MonthDayYear
Date
Identifier
Region of Intellectual Reference*
Place of Residence
City, State, Country
Zip Code*
I AFFIRM THAT:
- THE INFORMATION PROVIDED HERE IS TRUE TO MY KNOWLEDGE.
- I AM OF AFRICAN DESCENT OR OTHERWISE IDENTIFY AS A MEMBER OF THE BLACK DIASPORA.
- I AM AT LEAST 16 YEARS OLD.
- I CURRENTLY RESIDE IN THE LOCATION NAMED ABOVE.
Signature

Clear
Would you like to enlist as a volunteer registrar for future Speculative applications?

YesNo

Hotep Registration Form

HOTEP LITERACY EVALUATION