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