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Application For Membersh
In the Erisian Movement of the DISCORDIAN SOCIETY
1. Today’s date Yesterday’s date
2. Purpose of this application: --membership in: a. Legion of Dynamic Discord b. POEE c. Bavarian Illuminati d. All of the above e. None of the above f. Other--be specific!
3. Name Holy Name
Address
If temporary, also give an address from which mail can be forwarded
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
5. History: Education - highest grade completed 1 2 3 4 5 6 over 6th Professional: On another ream of paper list every job since 1937 from which you have been fired. Medical: On a seperate sheet labeled “confidential,”’ list all major psychotic episodes experienced within the last 24 hours
6. Sneaky questions to establish personality traits
I would rather a. live in an outhouse b. play in a rock group c. eat caterpillers. I wear obscene tattoos because
I have ceased raping little children | | yes | | no -- reason
7. SELF-PORTRAIT
LICK HERE!
(You may be one of the lucky 25)
Rev. Mungo
For Office Use Only- acc. rej. burned
00023
