ARM CPR CSA KKK
ARM CPR CSA KKK
American Rebel Militias
Confederate Phalange Rangers
Christian Survivalists Alliance
Keltic Klan Kirk
American
Rebel
Militias
Phalange 
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PRINT Rank & Name of American Rebel Militia Ranger
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Signature of American Rebel Militia Ranger
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Date of Enlistment into American Rebel Militias Phalange
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Brigade Number & Name of Unit or Cell Group and Home State