Membership Application

Membership

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NBPP Member Application

***Complete ALL information to the best of your knowledge. ***The NBPP 10 Point Platform, 9 Local Objectives, By-Laws and Requirements MUST be understood before approving application. ***Submission of this application means that you accept the conditions set forth by the NBPP. Black Power!

Date Submitted

Legal Name

Date of Birth

Preferred Name or any aliases

Gender Male Female

Ethnic Origin and Nationality (Black trapped in Amerikkka, Carribean, Latino, Native/Indigenous People)

Street Address

City

State

Zip Code

Home Phone

Cell Phone/Pager

Work Phone

Email Address

Social Security Number

Drivers License Number/State

High School

Graduated High School yes no

College (include course of study and degrees)

Graduate, Business or Trade School

Organizational Experience (list any local, regional or national affiliations)

Military Training/Armed Service Branch

How Many Years of Military Training

Date of Enlistment

Date of Discharge

Reason for Joining and Leaving

Discharge Status Honorable Dishonorable

Specialized Training (M.O.S, Recon, Navy Seal, Delta Force, Army Ranger)

Specialized Skills (Martial Arts, Electronice, Computers, Medical, Legal, Communications, Business, etc.)

List any medications you are currently taking and reason for usage

Have you ever been diagnosed with or hospitilized for any mental conditions. You must state when and reason.

Have you ever been incarcerated or convicted of a crime? Do you have any pending charges? Are you on probation or parole? (explain)

Why are you joining the New Black Panther Party

*** Upon completion of your application, based on the discretion of the leadership you will be appointed to an interview which will determine your eligibility for membership. ***

Understand that by completing this application you may be required to sign a confidentiality agreement, should you become a member. Understand that completion of this application and any interview which may be granted does not ensure acceptance into the organization. Understand that by completing this application the New Black Panther Party is not obligated to grant membership. Understand that all information given to the New Black Panther Party is confidential and will not be viewed by any outside personnel. If accepted for membership, new members are required to pay a $25 non-refundable new member fee. If accepted, member must agree to adhere to all the policies and procedure set forth by the New Black Panther Party. Violation of these laws may result in termination of membership.

ALL POWER TO THE PEOPLE!!! BLACK POWER!!!

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