White Camelia Knights of the K.K.K. 67309 White Rd

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					                       White Camelia Knights of the K.K.K.
                               67309 White Rd.
                             Coprophilia, TX 72260


                           MEMBERSHIP APPLICATION FORM

But first, a few words about us:
The White Camelia Knights of the KKK is a group of men and women (families) that
share a common belief in religion and race. We are not the Knights of the White
Kamellia, KKK. Neither do we have any affiliation to this organization.

We are an organization of Aryan Christians dedicated to the truth and education in a
world of lies and ignorance.

The White Camelia Knights of the KKK is based in Texas, but with membership spread
throughout many other states and countries.

The original White Camelia was organized in 1867, two years after the original Klan was
formed in Puluski, Tennessee. It has been reported that the White Camelia became larger
than the original Klan in membership and power.

The White Camelia Knights of the KKK believes that Aryan Christian ideals are under
attack by anti-Aryan and anti-Christ forces. We believe our race, country and our
Christian way of life is being systematically destroyed.

We hope that you will take some time to fill out this form and become part of our
amazing organization.

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Please PRINT answers to the following questions. Applications filled out using computer
and/or typewriter will not be accepted.

1. Please tell us about yourself:
        A. First name: _________________________________
        B. Last name: _________________________________
        C. Address: __________________________________
        D. Telephone: _______________________________
        E. Date of birth: ____________________________
        F. Location of birth: ________________________
        G. Ethnicity: _____________________________
       H. Political affiliation: ___________________________
       I. Father’s name: _______________________________
       J. What does he do? ____________________________
       K. Mother’s name: ____________________________
       L. What does she do? _________________________

2. Please fill out the following questions to the best of your ability. You may find that the
questions are very personal; this is because we value the health of our members and want
to grant membership to only the best (of moral and physical characteristics) of people. If
you do not understand a question, please skip it and ask your recruiting member for help
– they will explain it to you. Please be completely honest!

       a) About your mental health. Please mark your answer using the chart. Where
       applicable to you, please indicate whether they “Sometimes”, “Often”, or
       “Always” apply. Please do not mark all answers as “Never” – this means that you
       have cheated and are not taking this seriously. Please read each question and
       answer seriously.

Question                                            Never Sometimes Often Always
Do you live in a city?
Do you spend more than two hours a week in
traffic?
Have you spent a lot of time in a polluted
environment?
Do you experience physical or mental fatigue or
lethargy?
Do you get forgetful or confused?
Do you find it hard to think straight?
Do you have frequent mood swings?
Do you find it hard to deal with stress?
Are you often depressed?
Are you a terrorist?
Do you get deep depressions for no particular
reason?
Do you suffer with post-menopausal
depression?
Did you eat Mexican food for dinner?
Do you get suicidal thoughts?
Do you suffer from anxiety or irritability?
Do you have aggressive outbursts or crying
spells?
Do you get hyperactive?
Do you have difficulty sleeping or insomnia?
Do you suffer from nervousness?
Were you shy or over-sensitive as a child?
Do you ever feel ‘unreal'?
Question                                           Never Sometimes Often Always
Do you ever ‘hear' your own thoughts?
Have you ever had a ‘wet dream’?
Have you ever soiled yourself whilst driving an
automobile?
Do you see or hear things abnormally?
Are you naturally suspicious of people?
Do you have abnormal fears, compulsions or
rituals?
Do you suffer with delusions or illusions?
Do you suffer with manic depression?
Do you have schizophrenia?
Do you have extreme fears or paranoia?
Do you have violent or impulsive behaviour?
Do have inner tension or ‘driven' feeling?
Do you suffer with phobias?
Do you get angry or aggressive feelings?
Do you suffer with emotional instability?
Do you have obsessive or compulsive
tendencies?
Do you grind your teeth?
Are you restless?
Are you frequently tired?
Are you socially withdrawn?
Are your mental health symptoms often worse
after eating?
Have you ever soiled yourself whilst riding a
motorized cycle or scooter?
Do you have difficulty concentrating?
Are your mental health symptoms often worse
after eating fecal matter?
Do you have difficulty concentrating?
Do you have dyslexia or learning difficulties?
Are you an alcoholic?
Is your memory declining or are you becoming
forgetful?
Do you have a short attention span?
Have you ever soiled yourself whilst riding in a
train?
Do you have dyslexia or learning difficulties?
Is your stamina, or ability to keep going,
noticeably decreasing?
Do you use any drugs?
Do you have a lack of drive or motivation?
Do you have dyslexia or learning difficulties?
Question                                        Never Sometimes Often Always
Have you ever seen a grown man naked?
Do you rarely initiate or complete tasks?
Do you have difficulty visualizing?
Do you have difficulty learning new things?
Is this some kind of bust?
Do you get facial puffiness, circles or
discoloration around eyes?
Do you have dry or rough skin and/or hair?
Do you have stretch marks?
Is removed awesome or what?
Do you suffer from dry hair, hair loss or
dandruff?
Do you have pale skin that burns easily?
Do you cry yourself to sleep?
Do you get excessively thirsty?
Do you sometimes feel weak?
Do you have a giant wiener?
Do you feel drowsy after meals?
Do you have white spots on your fingernails?
Is your eyesight deteriorating?
Is your mental clarity or concentration
decreasing?
Does your skeet leak?
Are you intolerant to the cold or have cold
hands and feet?
Do you suffer from sore throats or nasal
congestion?
Do you get frequent colds and infections?
Do you have constipation, gas, bloating or
indigestion?
Did you have loose bowels or skin problems at
onset of mental health problems?
Do you suffer with nausea?
Do you gain weight easily?
Do you suffer from anal fungus?
Do you get muscle pain or tension?
Do you get joint pain?
Do you have a good pain tolerance?
Do you get headaches or migraines?
Do you have difficult orgasm with sex?
Do you have easy orgasm with sex?
Do you suffer with PMS, painful periods or
breast pain?
Do you have irregular menstruation?
Question                                          Never Sometimes Often Always
Are you a light sleeper?
Do you dream infrequently?
Are you having a hard time keeping your weight
stable?
Do you have a fast metabolism?
Do you produce a lot of body heat?
Do your farts smell like French fries?
Do you have crowded upper front teeth
Do you have little body hair and a lean build?
Do you have large ears or long fingers and toes?
Do you have a good tolerance of alcohol?
Do you get seasonal allergies (eg hayfever)?
Do you alcohol or drug abuse?
Do you have a poor tolerance of alcohol or
drugs?
Are you sensitive to pain (low pain threshold)?
Do you have raised blood pressure?
Do you have rapid or irregular heart beat?
Do you have a dry mouth?
Do you suffer from palpitations or blackouts?
Do you ever experience dizziness, trembling or
fainting?
Do you have a history of colic, eczema, asthma,
rashes or ear infections?
Do you suffer from frequent, rapid colds or a
blocked nose?
Do you have watery, itchy eyes, red eyelids or
dark circles under the eyes?
Do you have excessive mucus, a stuffy nose or
sinus problems?
Do you suffer with excess sweating and strong
body odour?
Do you suffer with indigestion or bloating?
Do you need a coffee, tea or cigarette to get you
going in the morning?
Do you get cravings for sweets or stimulants
(including coffee, tea, cigarettes)?
Do you have headaches or shaky feelings that
are relived by sugar, caffeine or cigarettes?
Do you smoke more than five cigarettes or half
a cannabis joint a day?
Do you need a drink most days?
Do you drink alcohol or take recreational drugs
on your own?
b) About your sexual health. Please place a ‘check’ mark by the answer that
applies to you.
        1. During sexual stimulation, foreplay, and/or intercourse, I experience the
        following sexual complaint(s):
        ( ) vaginal dryness
        ( ) lack of genital sensation (tingling/ warmth with sexual arousal)
        ( ) difficulty achieving orgasm
        ( ) loss of intensity of orgasm (orgasms feel muffled)
        ( ) genital pain either with or without sexual contact
        ( ) lack of sexual interest
        ( ) none of the above

       2. I feel that my sexual complaint(s) have affected my desire for sex. (In
       other words, if sex wasn't painful, frustrating, or no fun, I would be more
       interested.)
       ( ) I have no sexual complaints, just lack of desire
       ( ) I agree
       ( ) I disagree
       ( ) I'm not sure

       3. I notice that I have the same sexual difficulties with my partner as I
       have alone during self-stimulation or I am equally un-motivated or
       uninterested in self stimulating as being sexual with my partner.
       ( ) Yes
       ( ) No
       ( ) Don't know
       ( ) Don't self stimulate

       4. There was a time when I was satisfied with my sexual response and/or
       interest.
       ( ) Yes
       ( ) No
       ( ) Don't know

       5. I am presently being treated with medication and/or psychotherapy for:
       ( ) depression
       ( ) anxiety disorder
       ( ) any psychiatric illness
       ( ) none of the above

       6. I feel that:
       ( ) My partner knows what to do to sexually satisfy me.
       ( ) I am comfortable giving my partner direction about how to sexually
       stimulate me.
       ( ) I feel connected to and emotionally intimate with my partner.
       ( ) My general/sexual communication with my partner is adequate.
       ( ) Not applicable, I don't have a partner at this time

       7. I have a history of sexual abuse or trauma.
       ( ) Yes ( ) No ( ) Don't know
       If yes,
       ( ) I never told anyone
       ( ) I never pressed charges
       ( ) I did not receive counseling
       ( ) I feel this history affects my present sexual life
       ( ) None of the above


       8. The following conditions apply to me:
       ( ) I have had a hysterectomy or other pelvic surgery
       ( ) I am post-menopausal
       ( ) I have diabetes
       ( ) I have cardiovascular disease
       ( ) I smoke
       ( ) I am taking SSRI's (e.g. Zoloft or Prozac)
       ( ) I am taking birth control pills
       ( ) I have had one or more prolonged labor and deliveries (e.g. needed
       ventuse/suction)
       ( ) I have a history of straddle injury (fell on a bicycle, balance beam, etc.)
       ( ) I have had a back injury and/ or back surgery
       ( ) I have had a spinal chord injury
       ( ) I have had genital circumcision
       ( ) I have multiple sclerosis or other neurologic disorder
       ( ) I have had two or more children
       ( ) none of the above

c) Short-answer. Please fill ALL LINES for each question. Your application will
not be accepted unless all lines are filled in.
        1. Do you believe in complete Aryan Power? Please give examples.
        ____________________________________________________________
        ____________________________________________________________
        ____________________________________________________________
        ____________________________________________________________
        2. Are you a loyal person? Are you willing to dedicate yourself completely
        to our cause? Please give examples.
        ____________________________________________________________
        ____________________________________________________________
        ____________________________________________________________
        ____________________________________________________________
        ____________________________________________________________
       d) Essays. Five essay topics are listed below. You will choose 3 of the 5 essays
and respond to the prompt on the blank spaces that have been provided in this
application. Proper grammar is required, and it is expected that you do your best to
complete each prompt in a manner that will please the Board of Admissions.

       1. You have been chosen by us – The White Camelia Knights of the K.K.K. – to
          open a chapter of our organization in your country. Tell us what exactly you
          will do and how your doings will make you a beneficial member of our
          organization.
       2. Two trains begin traveling from opposite ends of Europe. Train 1 takes the
          Chunnel from London while Train 2 takes the route along the Autobahn. If
          Train 1 gets a flat tire near Bakersfield and Train 2's engine dies when Maury
          wasn’t paying attention. Please correctly divide the time traveled by the
          atomic weight of Boron.
       3. A stranger has mistakenly sent you $300,000 US. You have two choices –
          either give back the money, or keep the money for yourself. Which would you
          choose? Discuss positives and negatives about your choice.
       4. Discuss technological advances in your country. This is a vague topic, so lots
          of information is required. (PLEASE DO NOT CHOOSE THIS TOPIC IF
          YOU CANNOT WRITE ONE FULL PAGE ABOUT IT.)
       5. Discuss your experiences with the one-eyed trouser snake. Were they
          pleasurable? Were you the giver or the receiver?
6. THIS PAGE IS TO BE USED FOR YOUR FIRST ESSAY. PLEASE DO
   YOUR BEST TO FILL IN THE WHOLE PAGE. IF YOU CANNOT FILL
   IN THE WHOLE PAGE, FILL IN AS MUCH AS YOU POSSIBLY CAN.

        (PLEASE FILL IN PROMPT NUMBER BELOW)
    I HAVE CHOSEN TO WRITE ABOUT PROMPT NUMBER _
THIS PAGE IS TO BE USED FOR YOUR SECOND ESSAY. PLEASE DO YOUR
BEST TO FILL IN THE WHOLE PAGE. IF YOU CANNOT FILL IN THE WHOLE
           PAGE, FILL IN AS MUCH AS YOU POSSIBLY CAN.

            (PLEASE FILL IN PROMPT NUMBER BELOW)
        I HAVE CHOSEN TO WRITE ABOUT PROMPT NUMBER _
THIS PAGE IS TO BE USED FOR YOUR THIRD ESSAY. PLEASE DO YOUR BEST
 TO FILL IN THE WHOLE PAGE. IF YOU CANNOT FILL IN THE WHOLE PAGE,
                FILL IN AS MUCH AS YOU POSSIBLY CAN.

              (PLEASE FILL IN PROMPT NUMBER BELOW)
          I HAVE CHOSEN TO WRITE ABOUT PROMPT NUMBER _
Congratulations! You have reached the last page of the WCKKKK Membership
Application. Please read our final requirements and email the scans of this form to your
referrer, Mr. Dale Gribble, Grand Dragon.

Final requirements:
   1. Make sure that all information you have filled in is factual. It is a good idea to
        double (and triple) check your application.
   2. Locate a recent picture of yourself. Please email this picture to your referring
        member (Mr. Dale Gribble, Grand Dragon) so that we have a picture of the
        person we are granting membership to.
   3. Sign and print your name on the line at the bottom of this page. Signing there
        certifies that you swear that all the information you have given us true and factual.




I, _________________________, (your name) certify that all information in this forum is
valid and complete. This form was filled out by myself on the date of ____ (year) __
(day) __ (month) in _______________. (your city)


                                                       _____________________________
                                                                           (signature)

				
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