We invite you to fill out the application form below and mail same to—
Wm. E. Maxey, Jr., Executive Director
P. O. Box 1916
Richmond, Virginia (Telephone 2-8924)
Application Form
Defenders of State Sovereignty
and Individual Liberties
1210 Travelers Building
Richmond, Virginia
I hereby apply for membership in the Defenders of State Sovereignty and Individual Liberties. I am a law abiding citizen of the United States of America; and a resident of the County/or City ______________________, Virginia. I am not a member of any organization detrimental to the peace and welfare of the U.S.A., nor do I ever intend belonging to any such organization.
I believe the segregation of the races is a right of the state government; in the sovereignty of the several states and in the freedom of the individual from government controls.
I enclose $10.00 for membership in the Defenders of State Sovereignty and Individual Liberties for one year.
Witness my hand this ____________________ day of ____________________, 195_____.
Name ___________________________
Address _________________________
(Made checks payable to E. Floyd Yates, Treasurer)
