INDIAN CREEK BAND CHICKAMAUGA CREEK, INC.
SOUTHERN WOLF CLANS TEACHING COUNCIL

1352 East Lombardy Drive
Deltona, Florida 32725
Phone 386-574-3291

MEMBERSHIP APPLICATION

DATE OF APPLICATION ____________________________ DATE OF BIRTH (dd/mm/yyyy)______________________

NAME___________________________________________________________________________________________________________________________________
               (LAST)                                                                                               (FIRST)                                                          (MIDDLE)

ADDRESS________________________________________________________________________________________________________________________________
                                                      (STREET OR P.O. BOX NUMBER)

CITY__________________________________________________________________________ STATE___________________________ ZIP CODE________________

TELEPHONE #___________________________________________________________________ EMAIL: ___________________________________________________
(HOME)
SPOUSES NAME _________________________________________________________________ BIRTHDAY ____________Email:_______________________________
CHILDREN’S NAMES
1. _____________________________________________________________________________ BIRTHDAY________________________________________________

2. _____________________________________________________________________________ BIRTHDAY ________________________________________________

3. _____________________________________________________________________________ BIRTHDAY ________________________________________________

4. _____________________________________________________________________________ BIRTHDAY ________________________________________________

PLEASE PROVIDE THE FOLLOWING INFORMATION:
ARE YOU AN ENROLLED MEMBER OF A STATE OR FEDERALLY RECOGNIZED TRIBE (CIRCLE ONE)                     YES                 NO
ARE YOU OF NATIVE AMERICAN DESCENT? (CIRCLE ONE)                                                                            YES                  NO

IF YES PLEASE PROVIDE NAME OF TRIBE: _______________________________________________________________________________________________________

To become a full member, you are required to be Native American.  If you are not Native American, you can become an Associate Member of the ICBCCI. Once you become a member, and your name has been added to the tribe index, it cannot be removed, even if you have been banished from the tribe under the law of banishment.  You are subject to the laws of this Tribe and the United States Government.  These records are part of the Index File with the B.I.A. in Washington, D.C. A copy of the registration and financial information may be obtained from the Division of Consumer Services by calling (1-800-HELPFUL) REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE OF FLORIDA.  BY SIGNING THIS APPLICATION YOU ARE CERTIFYING THAT ALL STATEMENTS ARE TRUTHFUL, FAILURE TO DO SO WILL BE CONSIDERED PERJURY AND PUNISHABLE BY PROSECUTION.  MEMBERSHIP IS FREE OF CHARGE

APPLICANT SIGNATURE ____________________________________________________________________________ DATE __________________________________

Family Group Sheet

Each piece of information concerning a pedigree ancestor and his/her family is placed on a worksheet. Since the end result of your research efforts will be to compile complete, correct and connected families, the use of family group sheets from the beginning will make the compilation much easier.

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Ancestral Chart

An ancestor chart records the ancestors from whom you directly descend--those for whom you intend to compile a complete and correct family unit. It shows at a glance the progress you have made towards this goal and what remains to be done.

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Talent Survey - please complete and send with application, Fammily Group Sheet and Ancestral Chart