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.