Form cover
Page 1 of 2

SETejas Brown Beret Membership Application

Have you ever wanted to become a Brown Beret? We are committed to the community and the XicanX Movement and also stand in solidarity with all oppressed people and their causes. As a Brown Beret, you pledge to go the extra mile to push the liberation of La Raza. You pledge to preserving the history , advancement and liberation of La Raza.

Do you understand that we are NOT a terrorist group, and do NOT participate in violent crimes of any kind?

Do you understand that we are NOT a terrorist group, and do NOT participate in violent crimes of any kind?
A
B

What is your name on your birth certificate or I.D

Is there a nickname or alias you sometimes use or prefer to use?

What are your gender pronouns?

Do you identify as Xican/Xicano/a?

Do you identify as Xican/Xicano/a?
A
B

Provide the following:

Please provide us with a contact in case of emergency

Highest level of education?

Have you ever been convicted of a felony?

Have you ever been convicted of a felony?
A
Have you ever been convicted of a felony?
B

If yes , Explain

Are you a registered sex offender?

Are you a registered sex offender?
A
B

Have you ever been part of the U.S Military?

Have you ever been part of the U.S Military?
A
B

Are you currently employed or ever been employed by any law enforcement agency ?

Are you currently employed or ever been employed by any law enforcement agency ?
A
B

Do you have any self Defense/firearms training?

Do you have any self Defense/firearms training?
A
B

What will you be contributing to the organization and why do you want to join?

Do you feel it is important to preserve Xicana/Xicano culture and history?

Do you have any mental/medical issues that limit your participation in Brown Beret Activity? (If yes please explain)

What is your opinion on migration from across the continent to the U.S?

What is your stance on environmental issues?

Please list other Xicana/o/x organizations you work with.

Are you affiliated with any other organization?(If yes please list organization)

The South East Tejas Brown Beret organization has a monthly membership contribution of 20$ for employed members.(These Funds go towards events, traveling experiences)Are you okay with paying monthly dues?

The South East Tejas Brown Beret organization has a monthly membership contribution of 20$ for employed members.(These Funds go towards events, traveling experiences)Are you okay with paying monthly dues?
A
B

Do you give the South East Brown Beret Organization the right to do a background check?(If yes please sign with your signature)

Signature