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Member Contact Form
First Name (Full)
*
Middle Name
Last Name
*
Maiden Name (If Applicable)
Home Mailing Address
Street Address
*
Address Line 2
City
*
Province/Territory
*
Postal Code
*
Additional Contact Information
Home Phone Number
Cell Phone Number
Email Address
Confirm Email Address
Member Verification
Birthdate (Required for Verification and Voting)
*
+
First Nation Registration Number (Required for Verification and Voting)
*
For those that have provided an email address, a confirmation email will be sent after a successful form completion. Please check your SPAM or JUNK folders if the confirmation email is not in your INBOX.
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