Membership Application
The Southern Nationalist League, Inc.
Legal Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Confirmation Email
Enter your email again to confirm entry
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ID Entry
*Required
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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Day
Please select a year
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1921
1920
Year
Government Photo ID Number
*
Issuing Authority
*
Type of ID
*
Please include a front and back digital photo or scan of the above listed ID with this application
ID Photo Upload - Front
*
Browse Files
Drag and drop files here
Choose a file
Please upload image in .JPG file format
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ID Photo Upload - Back
*
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Please upload image in .JPG file format
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Background Information
*Required
Are you a current League Member?
*
Yes
No, I am renewing my lapsed (formerly LOTS) membership
No, I am a new member
What was the date of your last Membership renewal?
*
-
Month
-
Day
Year
NOTE - If you have sent your membership in manually and paid by check, please select the date you mailed in your membership with payment.
What is the level of your current Membership level?
*
Please Select
Individual Member
Spousal Member
Student Member
Patriot Member
Have you been referred by an existing or current League member?
*
Yes
No
Other
Please enter the new, existing or current League member's name
*
First Name
Last Name
Professional background
*
0/250
Number of total years as a working professional
*
What state do you currently reside in?
*
Number of total years in the current state of residence
*
Please describe what you expect to gain from being a member of The Southern Nationalist League
*
0/250
Please describe what skills and talents you can bring to The Southern Nationalist League
*
0/250
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Membership Selection
*Required
Indicate your paid Membership Subscription Level
Please select one. Check the membership level below that you will be paying for online. If updating a current LOTS Membership, please select the Membership level closest to your current level. Please note that our Membership levels have changed and pricing has been updated. Thank you.
Select your paid Membership Subscription Plan
Individual Annual Membership - $60 - 18 or older
Spousal Annual Membership - $85 - Husband & Wife
Family Annual Membership - $110 - Child ages up to 17
Southern Patriot Individual Annual Membership - $125
Southern Patriot Family Annual Membership - $200 - Child ages up to 17
Please select how many children ages 12-17 for a Family Membership and include their names
Please Select
1
2
3
4
Child Name - 01
First Name
Last Name
Child Name - 02
First Name
Last Name
Child Name - 03
First Name
Last Name
Child Name - 04
First Name
Last Name
Spouses Legal Name
First Name
Last Name
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Statement of Purpose Agreement
*Required
“We seek to advance to cultural, social, economic and political well-being and independence of the Southern people, by all honorable means.”
Please read and agree to uphold the Statement of Purpose of The Southern Nationalist League, Inc.
Signature
*
Use touch/finger or cursor to scribe your signature
Are you Paying by Check?
Yes
No
I have already mailed in my payment
Check Payments (mail-in) payable to: The Southern Nationalist League, Inc.
Acceptable forms of payment include - Personal Checks, Money Orders, Cashiers Check
I will mail-in acceptable payment in the amount for
*
Enter Amount of payment to be mailed in USD:
*
Enter the amount you will send payment for
Enter Amount of payment mailed in USD:
*
Enter the amount you have already mailed in payment for
Mail to: The Southern Nationalist League
P.O. Box 730 Killen, Alabama 35645
All Membership Submissions are Subject to Review and Acceptance
Upon successful receipt of payment and acceptance into The Southern National League, you will receive an email with further membership information. Payment must be received within 10 business days of submitting this Membership Form or application will be removed.
Audit Email
example@example.com
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