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[[preprinted form]] [[image - drawing of two hand clasping in a handshake]] APPLICATION BLANK - BLADENSBURG UNION I hereby make application for admission in The Blandensburg Union. Name ^[[George Vannester Ford,]] Street ^[[216 Tenth St. N.E.]] City or State ^[[Washington 2. D.C.]] Age last birthday ^[[42]] Month ^[[Nov. 25]] Year ^[[1906]] Beneficiary [[blank line]] 1. Voucher ^[[H. V. Plummer Chmn Board of Directors]] 2. Voucher ^[[Rosa E. Plummer]] [[double line]] This certifies that the above-named applicant is in good health. ^[[Wm. W. Spiller]] M.D. ^[[421 - 23d Pl. N.E.]] [[/preprinted form]]