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                               OFFICIAL         [Illustration:  a
                          DISCORDIAN SOCIETY    flaming eye-in-the-
                               HAIL ERIS        pyramid]

                       APPLICATION OF MEMBERSHIP

           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
    separate 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 caterpillars.  I wear obscene tattoos because _____________

    _________________.  I have ceased raping little children [ ] yes

    [ ] no -- reason:  ______________________________________________.

7.  Self-portrait

                                                  +------------------+
SENDER WAITING!                                   |   LICK HERE!     |
Answer by wire                                    |       ()         |
                                                  | (You may be one  |
Rev. Mungo                                        | of the lucky 25) |
For Office Use Only -- acc. rej. burned           +------------------+

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