I, ____________________________________, wish to become an affiliate of the Statesmanship Party. I declare support for the basic issues Statesmanship Party represents and that I will support the majority of the candidates and/or endorsees, if any, of the party.

As an affiliate, I understand that I am eligible to be elected or appointed to serve in any official position in the Statesmanship Party in accordance with Mo. laws and/or the By Laws. I understand, however, affiliation is not necessarily the same as membership.

I declare that I am a legal resident of and legally registered voter in the State of Missouri and have attached a copy of my voter registration card or other appropriate identification OR that I am applying as a student or non voter affiliate as provided within the Statesmanship Party policies and as I have indicated below.

I declare under penalty of perjury for false declarations, that I am a law abiding citizen and I do not promote violence or hatred nor violation of any state or federal laws.

I declare under penalty of perjury for false declarations, that I am not in any manner loyal to the Republican Party and that I am not a government operative or agent for any other political party or entity, foreign or domestic.

Signature:_________________________________________________________

Date: ____________________________________________________________

Printed name:______________________________________________________

Printed FULL ADDRESS, PHONE, FAX, E MAIL: __________________________________________________________________________________

County_____________ Precinct_____________ Ward________Cong. Dist.____________

State Senate Dist.__________ Mo. House Dist.__________ Judicial Dist.______________

Issues you are particularly interested in ____________________________________________________________________________________________

________Applying as a student affiliate. My birthdate is ___________. I understand a student affiliate cannot vote in the business of the party except as provided in the bylaws. I further understand student affiliates are known as Freedom Torch Bearers.

_______ Applying as a non-voter because __________________________________________. I understand a non -voter affiliate cannot vote in the business of the party. I further understand non-voter affiliates may belong to a group as Freedom Torch Auxiliary.

Affilation is FREE, but donations are encouraged. Levels of affiliation are available as follows:

GOLD TORCH AFFILIATION-over 100 hours or over \$100 in kind donations or over $100 donation per year.

SILVER TORCH AFFILIATION-at least 100 hours or at least \$100 of in kind donations or up to $100 donation per year.

BRONZE TORCH AFFILIATION-up to 100 hours or up to \$100 in kind donations or up $100 donation not otherwise covered.

FREEDOM TORCH AFFILIATION-at least ten hours or \$10 of in kind donations per year or $10 donation.

LIBERTY TORCH AFFILIATION-free participation for all, no donations or in kind donations or standard of participation expected.

Students and non-voters may earn participation as a supporter at any of the above levels. Students and non-voters may also participate in a Freedom Torch Auxiliary without any donation and students may participate in Freedom Torch Bearers of Statesmanship Party as the students establish the guidelines thereof.

Anyone participating as a voting affiliate of the party must sign this application. Family or business may earn the levels of type of affiliation as a group however. Each individual is responsible for requesting the appropriate level of affiliation. (Also available bronze, silver, gold supporter with same in kind or actual donations as above noted. Supporters do not have to sign this application and cannot vote in party business) Affiliate cards or other privileges may be used. The Board of Directors shall resolve all disputes over levels of affiliation treating everyone fairly and equally under the law and within the bylaws.

PLEASE BE SURE TO PROVIDE A COPY TO YOUR COUNTY COMMITTEE CHAIR, STATE SENATE DISTRICT COMMITTEE CHAIR AND CONGRESSIONAL DISTRICT COMMITTEE CHAIR, if any, AND RETAIN A COPY FOR YOUR RECORDS. Donations should be made payable to: Statesmanship Party and mailed to the above address or to Gerald Godfrey, Treasurer, Statesmanship Party, Rt. 4, Box 264F, Warsaw, Mo. 65355. Donations of $25 or more per year require submission of your name, address, and employer at the time you make the donation. If you use the donate online process
10 per cent of your donation goes to costs of maintaining the ability to collect funds online via Politics Online.