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[[pre-printed]]Application--Bladensburg Union.

City or Town: [[/pre-printed]]Berwyn. 
[[pre-printed]]State: [[/pre-printed]]Md.
[[pre-printed]]Month: [[/pre-printed]]Aug
[[pre-printed]]Date: [[/pre-printed]]3.
[[pre-printed]]Year: [[/pre-printed]]1908.

[[pre-printed]]I hereby make application for admission into the Bladensburg Union.
Age last birthday [[/pre-printed]]not given [[pre-printed]]years.[[/pre-printed]]
James. Gray.
[[pre-printed]]Name of Applicant.[[/pre-printed]] $1 bal. due $4 Paul W.E.B.
[[pre-printed]]This certifies that the above named applicant is in reasonably good health.[[/pre-printed]] 
Not given
[[pre-printed]], M.D.[[/pre-printed]]