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 *

Mailing Address: PO Box/ Street Address *

Community *

Province/Territory *

Postal Code *

Phone/Cell Number

E-Mail Address

PART 2: CHILDREN & DEPENDENTS

INSTRUCTIONS

List all your children 15 years old or younger.

Each child (15 years or younger) seeking membership to the NWT Métis Nation will require a separate application to be submitted by a legal Parent or Guardian.

If you have no children to declare please proceed to Part 3 of the Application

Child 1 Given Names

Child 1 Last Name

Date of Birth

Child 2 Given Names

Child 2 Last Name

Date of Birth

Child 3 Given Names

Child 3 Last Name

Date of Birth

Child 4 Given Names

Child 4 Last Name

Date of Birth

Child 5 Given Names

Child 5 Last Name

Date of Birth

Save & Return

Save your progress and complete this form later. (optional)