1. Name, patronymic, and surname..... Vladimir Ilyich Ulyanov

[Note on delegate status]: consultative / decisive
2. Delegate card No. ---------------------------- No card yet [status: decisive]
3. By which organization delegated......... Center
4. Age.........50 yrs.
5. Education........higher
6. Former profession (state precisely) or what specialties do you know......... Writer
7. Nationality.......... Russian
8. Since when have you been a member of the RCP (year, month).........1893, formally 1898
9. What party work do you perform now......... Member of the Central Committee
10. What Soviet work do you perform now.......... Chairman of the Council of People's Commissars and Chairman of the Council of Defense
11. Of what trade unions are you currently a member..........none
12. Did you belong to any party before joining the RCP, when, for how long.........no

Signature.......... V. Ulyanov (Lenin)
September 20, 1920