Metis Nation of Alerta Metis Nation Registry 100 Delia Gray Building 11738 Kingsay Avenue Edmonton Alerta T5G 0X5 Phone: 780.455.2200 Toll Free: 1.866.678.7888 UNDER THE AGE OF 16 YEARS Application for Metis Nation of Alerta Memership GENERAL INFORMATION AND INSTRUCTIONS Failure to complete all the required sections of this form ill result in your application eing returned to you. Entitlement to a Metis Nation of Alerta Memership Requirements Checklist Metis - a person ho self identifies as Metis, is distinct from other Aoriginal peoples, is of historic Metis Nation Ancestry and is accepted y the Metis Nation. A Métis must provide historical proof of his or her status as Métis: a) Historical Proof evidence of an ancestor ho received a land grant, or a scrip grant under the Manitoa Act or the Dominion Lands Act, or ho as recognized as a Métis in other Government, church or community records ) Historic Métis Nation means the Aoriginal people then knon as Métis or Half-Breeds ho resided in Historic Métis Nation Homeland; c) Historic Métis Nation Homeland means the area of land in est central North America used and occupied as the traditional territory of the Métis or Half-Breeds as they ere then knon Métis Homeland: The Homeland Geographically, races all three Prairie Provinces (Manitoa, Saskatchean and Alerta) also parts of Ontario, Northest Territories and British Columia Applications All applications are processed through the Provincial Office of Metis Nation of Alerta: Metis Nation of Alerta Metis Nation Registry 100 Delia Gray Building 11738 Kingsay Avenue Edmonton Alerta T5G 0X5 Regional Contact Phone Numers A completed Genealogy (Family Tree) hich clearly outlines your Métis ancestry to the mid 1800 s. Copy of ONE of the folloing: 1. Live Birth Registration 2. Long Form Birth Certificate shoing the full names of iological parents 3. Copy of aptismal certificate ith Church seal legile and officiates signature PLUS allet-size irth certificate Proof of permanent residency in Alerta for a minimum of ninety (90) consecutive days may e required. One (1) piece of photo identification of legal guardian or parent Additional documents or information may e requested in support of this application SAMPLE Replacement Card If you require a Replacement card please contact the Provincial office. There is a $40.00 replacement fee should you have yours lost/stolen. We accept cash or Money order ONLY. Payale to The Metis Nation of Alerta. It is the responsiility of the applicant to keep our office updated if you should move or your contact information changes Applications can e picked up in your Regions and also dropped off hen filled out completely: Region I Provincial Office Ph: 780-623-3039 Ph: 780-455-2200 1-800-252-7553 Region II Ph: 780-826-7483 Region V Ph: 780-849-4654 Region III 1-866-849-4660 Ph: 403-569-8800 1-800-267-5844 Region VI Ph: 780-624-4219 1-800-668-5319 Family Tree Information All applications REQUIRE a Family Tree starting in their name. If you are going to reference a family memer s Family Tree already on file you need to e ale to sho your link to them and your on Tree needs to go ack to at least your Grandparents. You need to state the family memers full name, date of irth and their MNA Memership Numer (if applicale)
Proof of Canadian Citizenship CERTIFICATE OF BIRTH IN CANADA - You may otain a irth certificate from the Vital Statistics authorities of your province or territory of irth. CERTIFICATE OF CANADIAN CITIZENSHIP - If you require a certificate of Canadian citizenship, contact: In Canada, the office of the Registrar of Canadian Citizenship: 1-888-242-2100 Wesite:.cic.gc.ca Photo Specifications Your Memership card process ill e sloed don consideraly if the folloing guidelines are not folloed: IMAGE INFORMATION: Photos must e taken ith uniform lighting and not sho shados or flash reflection on the face and head Photos must sho a full front vie of the face ith oth edges of the face shoing clearly. The face and shoulders must e centered in the photo and squared to the camera Eyes must e open and clearly visile. Glasses, including tinted ones ith prescription, may e orn as long as the eyes are clearly visile. Sunglasses are unacceptale The image must e clear, sharp and in focus Photos must e taken against a plain, uniform, hite or light colored ackground Photos must reflect/represent natural skin tones Hats or head coverings are not permitted except hen orn for religious reasons and only if the full facial features are clearly visile Photos must e in color Digital Photos may e e-mailed to registry@metis.org (please ensure you have your irth date and full name on the e-mail) or you can go to your Regional Office/Provincial Office to have your photo taken. Personal Information Protection Policy: The information you provide is collected under the authority of the Métis Nation of Alerta Association ylas. This information is collected for the purpose of memership registration and any information you provide is protected under the Metis Nation of Alerta Personal Information Protection Policy. Harvesting: Information on Harvesting can e found on our esite. Please feel free to visit our esite for further information: http://.alertametis.com
Metis Nation of Alerta #100 Delia Gray Building 11738 Kingsay Avenue Edmonton AB T5G 0X5 Ph: (780) 455-2200 Toll Free: (866) 678-7888 Fax: (780) 452-6035.alertametis.com MNA ID#: LIFETIME MEMBERSHIP Ne Application File Update Male Female PRINT NAME: Last First Middle ADDRESS: Apt# Street City Province Postal Code Home Phone: Message/Cell Phone: E-mail Address: Are you a Settlement Memer? Yes No Settlement: Metis Local #: Birth Date (YYYY/MM/DD) Place of Birth (City, Ton, Village) Province Fathers Last Name Fathers First/Middle Name Fathers Date of Birth Mothers Last Name Mothers First Name Mothers Maiden/Alias Name Mothers Date of Birth PROOF OF CANADIAN CITIZENSHIP To e completed y all applicants Are you a citizen of another country? Yes No If Yes (specify) Country Effective Date: If Born in Canada Birth Certificate Registration Numer: Certificate of Canadian Citizenship Registration Numer: Date of Issue: Date of Issue: I AM: Metis First Nation Inuit Non-Aoriginal My Child has een a permanent resident of Alerta since: (YYYY/MM/DD) DECLARATION I solemnly declare that I am the (Name of Declarant) (parent/guardian) Of (child s name) and that the statements made in this application are true Signature: Date: Signed at, AB FOR PROVINCIAL/REGIONAL OFFICE USE ONLY Region: Application Date: Intake Officer:
Metis Nation of Alerta STATUTORY DECLARATION: NOT ON INDIAN REGISTRY / BAND LIST This information is eing collected for the purpose of documenting an application for Memership in the Metis Nation of Alerta under the Bylas of the Metis Nation of Alerta Association. This information ill e securely stored under the control of the Metis Nation of Alerta. It is protected from disclosure to unauthorized persons or agencies pursuant to the provisions of the Personal Information Protection Act. Under the Act, you have the right to request access to your personal information held y the Metis Nation of Alerta, and to correct corrections should you elieve the information contains errors or omissions. In the matter of an application for Memership in the Metis Nation of Alerta and In the matter of Non-registration on the Indian Registry System and/or Band List TO WIT: I,, (Complete name of Declarant) Of (name of city, ton), in the Province of Alerta, solemnly declare that I am the of and (Parent/Guardian) (Child's Name) That Act, (Child's Name) is not registered on the Indian Registry System, pursuant to the Indian and/or a Band List, and that I ill immediately inform the Metis Nation of Alerta should my child ecome registered on the Indian Registry System pursuant to the Indian Act and/or a Band List. I make this Declaration conscientiously elieving it to e true and knoing that it has the same force and effect as if made under Oath. Declared efore me at (City, ton, village) in the Province of Alerta (Signature of declarant) It is a criminal offence to make a false declaration On (Date) (Signature of Commissioner for Oaths)
Aoriginal Affairs and Northern Development Canada 630 Canada Place 9700 Jasper Avenue Edmonton, AB T5J 4G2 Attention: Indian Registration and Band Lists I of in the province of Alerta (name of parent/guardian) (name of city, ton) declare that I am the of and that (parent/guardian) (child's name) date of irth is and is under the age of 18 years (child's name) therefore as the Parent/Guardian I herey consent to a search on the Indian Register to determine if (child s name) is listed in the Indian Registry. I have enclosed a copy of their irth certificate. Please release this information to M6tis Nation Registry, 100-11738 Kingsay Ave., Edmonton, AB T5G 0X5 Thank you, (signature) (address) (date) AANDC OFFICE USE ONLY Not Registered Is Registered If Registered Date Date Checked Indian Registration and Band Lists Aoriginal Affairs and Northern Development Canada
REGISTRY FAMILY UNIT Name: Birth Date: Name (please print) Birth Date Indicate Son-Daughter or Siling (please circle) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Please List Names of all your Children and/or Silings Notes:
METIS NATION OF ALBERTA Metis Identification Registry Department 8 16 4 G-Great G-Father's name Applicant's Name: Great G-Father's name 17 Date of Birth: m 9 18 G-Great G-Mother's maiden name 2 Metis ID # Grandfather's Name 19 10 20 m 5 G-Great G-Father's name Great G-Mother's (maiden) name d 21 1 Metis ID # m 11 22 Your Father's Name G-Great G-Mother's maiden name Metis ID # 23 m 12 24 d 6 G-Great G-Father's name Great G-Father's name Metis ID # 3 25 G-Mother's (maiden) Name m 13 26 G-Great G-Mother's maiden name m Metis ID # 27 d 14 28 Metis ID # 7 G-Great G-Father's name LEGEND Great G-mother's (maiden) name = Date of Birth 29 = Where Person as Born m = Date of Marriage m 15 30 = Where Person as Married G-Great G-Mother's maiden name d = Date of Death = Where Person Died Metis ID # = Memership Numer Metis ID # 31 MIR-002 -A
METIS NATION OF ALBERTA Metis Identification Registry Department 8 16 4 G-Great G-Father's name Applicant's Name: Great G-Father's name 17 Date of Birth: m 9 18 G-Great G-Mother's maiden name 2 Metis ID # Grandfather's Name 19 10 20 m 5 G-Great G-Father's name Great G-Mother's (maiden) name d 21 1 Metis ID # m 11 22 Your Mother's Maiden Name G-Great G-Mother's maiden name Metis ID # 23 m 12 24 d 6 G-Great G-Father's name Great G-Father's name Metis ID # 3 25 G-Mother's (maiden) Name m 13 26 G-Great G-Mother's maiden name m Metis ID # 27 d 14 28 Metis ID # 7 G-Great G-Father's name LEGEND Great G-mother's (maiden) name = Date of Birth 29 = Where Person as Born m = Date of Marriage m 15 30 = Where Person as Married G-Great G-Mother's maiden name d = Date of Death = Where Person Died Metis ID # 31 Metis ID # = Memership Numer MIR-002 -A