Missouri League of the South

                                             MEMBERSHIP APPLICATION

Name: __________________________________________________________________________

Address: ________________________________________________________________________

City: ____________________________________________________________________________

State: ________________________________ Zip Code : _________________________________

Telephone: ______________________________ Alternate Number: _________________________

E-mail: __________________________________________________________________________

Signature: _______________________________________________________________________

By my signature above, I am agreeing to  uphold the statement of purpose of The League of the South:

"We seek to  advance the cultural, social, economic, and  political well-being and  independence of the

Southern people by  all honourable means."

DATE:  _________________________________________________

National Annual benefits include a bimonthly newsletter, invitations to all meetings, conferences, and seminars;

and periodic mailings of organization literature.   Continuing memberships may include additional benefits.

Membership Options:

____ $50 Regular - Annually (National League of the South)

____ $10 Associate - Annually (Missouri League of the South)

____ Free Official Supporter

Please ask about other membership options.

Dues and contributions to The League of the South are not tax deductible.   Also, please note that applicants residing outside the

U.S. should add $5.00 to the appropriate category.

Mail check or money order to:  Missouri League of the South, P.O. Box 311, Nevada, Missouri, 64772

Amount Enclosed: _____________________________