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Version 1.180701
NORTHWEST TERRITORY MÉTIS NATION
Online Membership Application Form
Please select the option that pertains to the Applicant
An Applicant 16 years or older on the date of application submission
A parent/guardian of an Applicant who is 15 years or younger on the date of application submission
A guardian applying on behalf of an Applicant who is legally incompetent by reason of mental incapacity
PART 1: PERSONAL INFORMATION
NOTE: Questions with a red asterix
*
are required fields.
If under 16 years old what is your Parent/Guardian's Name (if applicable)
Applicant First Name?
*
Applicant Middle Name
*
Applicant Last Name?
*
Gender
*
Female
Male
Unspecified
Maiden Name (if applicable)
Nickname (if any)
Date of Birth
*
+
City/Town of Birth?
*
Province/Territory
*
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Other
Mailing Address: PO Box/ Street Address
*
Community
*
Province/Territory
*
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Other
Postal Code
*
Phone/Cell Number
E-Mail Address (highly recommended)
🛈
PART 2: CHILDREN & DEPENDENTS
INSTRUCTIONS
Each child (15 years or younger) or Adult Dependent seeking membership to the NWT Métis Nation
will require a separate application
to be submitted by a legal Parent or Guardian.
Save & Return
Save your progress and complete this form later. (optional)
Create an account or login
NWT Metis Nation Online Application