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[[preprinted]] Application-Bladensburg Union. City or Town: State: Month: Date: Year: ^[[Brentwood Md Oct 5. 1908]] I hereby make application for admission into the Bladensburg Union. Age last birthday ^[[31.]] years. [[signature]] ^[[Walter R Davis]] [[/signature]] Name of applicant. ^[[$1 - $4 bal. due. Paid W.E.B.]] [[double line]] This certifies that the above named applicant is in reasonably good health. ^[[Not given]] , M. D. [[/preprinted]]