First published in 1930 in Lenin Miscellany XIII.
Printed from the form filled in part by Lenin.
Source: Lenin Collected Works, Progress Publishers, 1971, Moscow, Volume 42, page 462.
Translated: Bernard Isaacs
Transcription\Markup: R. Cymbala
Public Domain: Lenin Internet Archive (2004). You may freely copy, distribute, display and perform this work; as well as make derivative and commercial works. Please credit “Marxists Internet Archive” as your source. • README
1. Name in full: Vladimir Ilyich Ulyanov 2. Are you attending as debating or voting delegate: 3. Delegate’s card No.: 4. What organisation have you been delegated by: Moscow 5. Age: 52 years 6. Nationality: Russian 7. Education: university 8. What social group do you belong to (worker, peasant, office employee): 9. How long have you worked at your profession: 28 years as litterateur 10. What Party work are you doing at the present time: member of the C.C.,R.C.P. 11. What administrative work are you doing at the present time: Chairman of the C.P.C. and C.L.D. 12. What part are you taking at the present time: a) in the co-operative movement } } no part b) in the trade union movement } 13. When did you join the R.C.P. ... ... at its foundation (1895) 14. Did you previously belong to any other parties, when, which: No Signed: V. Ulyanov (Lenin)
27th of March 1922
 The answers printed in small type are in the handwriting of Lenin’s sister Maria.—Ed.