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>How to Become a New Black Panther
Download Membership Application as PDF
(fill out and mail to NBPP-HQ... info on contact page)
Or... fill out and submit our new online form!
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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