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^[[Join for $500]] [[preprinted]] Application-Bladensburg Union. City or Town: State: Month: Date: Year: ^[[Bladensburg Md. [[strikethrough]] July [[/strikethrough]] Nov 2 [[strikethrough]] 1905 [[/strikethrough]] 1925.]] I hereby make application for admission into the Bladensburg Union. Age last birthday ^[[20]] years. ^[[$100]] [[signature]] ^[[George Thomas Green.]] [[/signature]] Name of applicant. [[double line]] This certifies that the above named applicant is in reasonably good health. [[signature]] ^[[H. T. Willis]] [[/signature]] , M. D. [[/preprinted]]