MEMBERSHIP APPLICATION

Name_____________________________Nickname_________________________

Address____________________________________________________________

City/State________________________________________Zip________________

Telephone # home___________________________work_____________________

pager____________________

Age_____Birthdate____________Nationality______________________________

Occupation_________________________________________

1. Why do you want to become a member of the Universal Zulu Nation?___________

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2. What do you know about the Universal Zulu Nation?_______________________

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3. What school do you attend?__________________________________________

4. What grade are you in?______________________________________________

5. What are your favorite subjects and your string points as far as academic achievements?______________________________________________________

6. What are your hobbies and/or your intrests?______________________________

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7. What skills do you have to offer the Universal Zulu Nation?__________________

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8. What ideas could you contribute to the Nation?___________________________

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9. What occupation do you wish to have as a career?_________________________

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10. What do you feel are your best assest that will help the Universal Zulu Nation?_

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11. What is your opinion of honesty?_____________________________________

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12. What is your opinion of loyalty?______________________________________

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13. What is your opinion of predjudice?___________________________________

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14. What is your opinion of drug/alcohol abuse?_____________________________

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15. What is your opinion on violence? ____________________________________

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16. What do you feel are the benefits you will receive from being a member of the Universal Zulu Nation?________________________________________________

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17. How do you think you could help your community and society by being a member of the Universal Zulu Nation?___________________________________________

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18. In your opinion, what would make you a sucess in life?____________________

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19. What do you thinnk is the best way to gain respect?______________________

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20. What do you feel your cultue brings to your community and to society?________

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21. What do you think your culture could bring to the Universal Zulu Nation?______

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22. What is your opinion on self defense?_________________________________

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23. Have you ever studied self - defense?__________

24. What style?______________________________

25. How long?_______________________________

26. Did you achive a rank?______________________

27. How high?_______________________________

28. Do you have children?______________________

29. How many?______________________________

30. In detail, give a personal opinion of yourself:____________________________

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Please Print This Form Out After You Have Filled It Out. Mail this form along with a certified check or money for $25 (membership fee) and three passpart pictures.

Annual Dues $25

Mail To:

The Universal Zulu Nation
PO BOX 510
Bronx, NY 10475 U.S.A.

Allow 6-8 weeks for processing

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