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Application For Membership In the Erisian movement of the DISCORDIAN SOCIETY 1. Today's date Yesterday's Date |
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2. Purpose of this application: membership in :
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3.Personal Name Holy Name Address (If temporary, also give an address from which mail can be forwarded) |
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| 4. Description: Born: Yes No Eyes: 2 Other Height: fl. oz. |
Last time you had a haircut: Reason: Race: Horse Human I.Q.:150-200 200-250 250-300 over 300 |
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| 5. Historical: Education - highest grade completed 1 2 3 4 5 6 over 6th |
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Medical: Warning! CONFIDENTIAL! |
Professional: FOR PUBLIC RIDICULE |
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| 6. Sneaky Questions to establish personality traits | ||||
| I wear obscene tattoos because I have ceased raping little children yes no Reason |
I would rather |
7. Self Portrait |
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| Rev. Mungo For Office Use Only Accepted Rejected Burned |
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I hereby certify that all the infornation on the above form is as true as I care to make it without actualy going out and purchasing more than 5 kilos of papier mache.
I an not guuily of the Murder of Rasputin, nor would I ever think of Overthrowing the US. Govt. even on a Sunday.
