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Alapaha River Band of Cherokee Inc. Tribal Membership ApplicationName ____________________________________________________ Spouse___________________________________________________ Indian Name (if any) ________________________________________ Address___________________________________________________ City__________________________ State________ Zip_____________ Phone ______________________________ E-mail ____________________________________________________ List your children’s names, birthdates and sex (additional names can be put on back of application) __________________________________ __________________________________ __________________________________ __________________________________ Your Personal Information: (This will be on the I.D. card) Eye Color ____________________ Height_______________________ Hair Color ____________________Weight ______________________ Date of Birth _______________________ Sex: Male Female (circle one) Signature: _________________________________________________ Date: _____________________________________________________ Do not attach a copy of your birth certificate to this application. All we need for identification is a valid drivers license or any other type of photo identification. Also send a passport photo for your Tribal I.D. card or attend one of the meetings and your I.D. will be made at that time. We ask that you include with your application. photo I.D. and passport photo, a $10.00 donation. This is for lifetime membership into the tribe and to cover the cost of making your card. Make donations payable to the; Alapaha River Band of Cherokee Inc. All information received on you is confidential and is protected under the privacy act. Mail Applications to: Chief Joan Thomas Nelson Alapaha River Band of Cherokee Inc. 3589 NW 28th Terrace Jennings, FL 32053 The Alapaha River Band of Cherokee, Inc A Notarized Statement
I, __________________________________ do hereby affirm that the information submitted on my tribal application to the Alapaha River Band of Cherokee Inc, is a fact and is true to the best of my knowledge. Genealogy Information for the tribal application was obtained from ( please check all that apply): ______ Birth Certificate ______ Death Certificate ______ Family History (orally passed down through the family) ______ Family Bible ______ Other (example) Historical Society, Census, etc. (please explain) ________________________________________________________________________ Signature of Applicant:_____________________________________________________ Date ___________________________ State of _________________________ County of _______________________ Before me, a Notary Public, appeared the above named who acknowledged and signed the foregoing instrument and their signing was their free act. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my seal this ________ day of __________, 20_____. Notary Public_____________________________________ My commission expires_____________________________ |
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