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Kitpu First Nation


Membership in the Kitpu First Nation Mi'kmaq Community
Kitpu First Nation Membership Application:
Your Full Name: _________________________________

Your Date of Birth:______________ Your Place of Birth:______________

Your Present Address:_______________________________
Prov: ____________
Postal Code:______
Telephone No.: (____ )_______________
Email Address:_________________________

Mi'kmaq ancestry is claimed from: _______________________________________

__I am transferring from another band. Name of band: ___________________
__I am not transferring from another band.

My family Member already in the Kitpu First Nation Band (if known):

Name:_____________________Relationship to you:____________Member #:___________

My child/children under 19 applying with me:


I am a resident of the Province of Newfoundland & Labrador
Yes___ No___,  If no, Province of ____

SIN. #: _________________ Occupation (optional): ____________       

I hereby certify that the above information is true and correct. I further certify
that I am not a member of any other aboriginal band.

Applicant signature:________________________________Date: ____________
Additional Information: ______________________________________________

Approved on: ________ Signed by Secretary: _______________________

Please mail to: Kitpu First Nation  332 Site 1 RR 1 Aguathuna NL A0N 1A0    A self-addressed-stamped-envelope is required to send your acceptance letter.

2005 © Kitpu First Nation