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[[preprinted]]
Application-Bladensburg Union.
City or Town: State: Month: Date: Year:
^[[Bladensburg Maryland Feb. 24 1914.]]
I hereby make application for admission into the Bladensburg Union.
Age last birthday ^[[thirty-seven]] years.
^[[$1]] [[signature]] ^[[Thomas A Wheeler.]] [[/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]]

Transcription Notes:
Not sure if it's H.T. or H.J. Willis (Its H. T. Willis)