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-23- |
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OFFICIAL [Illustration: a |
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DISCORDIAN SOCIETY flaming eye-in-the- |
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HAIL ERIS pyramid] |
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APPLICATION OF MEMBERSHIP |
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In the Erisian Movement of the DISCORDIAN SOCIETY |
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1. Today's date Yesterday's date |
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2. Purpose of this application: -- membership in a. Legion of |
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Dynamic Discord b. POEE c. Bavarian Illuminati d. All |
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of the above e. None of the above f. Other -- be SPECIFIC! |
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3. Name: __________________________. Holy Name: _________________. |
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Address: _______________________________________________________. |
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If temporary, also give an address from which mail can be forwarded |
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4. Description: Born [ ] yes [ ] no. Eyes [ ] 2 [ ] other. Height: |
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_____ fl. oz. Last time you had a haircut: |
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Reason: __________________________________. Race: [ ] horse |
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[ ] human. I.Q.: 150-200 200-250 250-300 over 300. |
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5. History: Education -- highest grade completed 1 2 3 4 5 6 |
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over 6th. Professional: On another ream of paper list every job |
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since 1937 from which you have been fired. Medical: On a |
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separate sheet labeled "confidential," list all major psychotic |
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episodes experienced within the last 24 hours. |
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6. Sneaky questions to establish personality traits: |
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I would rather a. live in an outhouse b. play in a rock group |
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c. eat caterpillars. I wear obscene tattoos because _____________ |
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_________________. I have ceased raping little children [ ] yes |
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[ ] no -- reason: ______________________________________________. |
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7. Self-portrait |
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+------------------+ |
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SENDER WAITING! | LICK HERE! | |
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Answer by wire | () | |
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| (You may be one | |
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Rev. Mungo | of the lucky 25) | |
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For Office Use Only -- acc. rej. burned +------------------+ |
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