Membership Application Form

Contact Information
Do you have a Band membership or can you trace ancestry to the Kwakwaka'wakw?		Yes No
If yes, provide a Band Name:
and a Band Number:
Check one for the annual fee plus GST (Band members are GST exempt):
		$20.00 Canadian Individual $35.00 Canadian Family $35.00 Individual International $70.00 International Family
Name:
Email:
Shipping:
City:
Zip Code:
Phone:
Business Phone:
Name of other Family:		Adult
Children under 19 years:		Birthdate
Gilakas’la for your support.