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[[preprinted]]
Application - Bladensburg Union.
City or Town: State: Month: Date: Year:
^[[Bladenburg Md. Oct 12. 1908]]
I hereby make application for admission into the Bladenburg Union.
Age last birthday ^[[32.]] years.
[[signature]] ^[[Garfield Bailey.]] [[/signature]]
Name of Applicant
^[[$1 bal due $4. Paid W. E. B.]]
[[double line]]
This certifies that the above named applicant is in reasonably good health.
^[[Not given]] , M. D.