CMT Membership Application--HOUSE EDWARDS

Creek of Midwest Ta'Meri Membership Application--HOUSE EDWARDS

This membership form is reserved for HOUSE OF EDWARDS--CHIEFESS BLACK RAVEN
Birth Name*

First NameLast Name
Tribal Name

First NameLast Name
Which bloodline in House Edwards do you descend from?*

ColemanWilderAddisonEdwardsWashingtonGreenEcholsNon-Bloodline AffiliatedNone of the above
Date of birth*

MonthDayYear
Date
Place of Birth*
Type birthplace City, State or Country outside of US
Last 5 digits of SSN*
Gender*

MaleFemale
Profile Photo*

PLEASE TAKE A PHOTO FROM YOUR BUST UP TO THE TOP OF YOUR HEAD ON A SOLID WHITE BACKGROUND
Cancelof
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Residence*
Please type in the County in which you currently reside.
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
FRONT PHOTO OF VALID STATE ID*

Please take a photo of your valid state ID. Passports and/or Birth Certs accepted in proper format.
Cancelof
Are you INDEXED by the Universal World Court (UWC)? *All Chiefs/Clan Mothers of the CMT/UNITT are Indexed by the UWC. Therefore, all house members will be indexed under the Clan as well.*

YesNo
List all children in your home under the age of 21. Include full FIRST & LAST NAME, DOB, LAST 5 SSN
List each child using 1 line for each for example: 1. Jane Doe, 1/1/2010, 12345
Membership Type (you will be direct billed accordingly under separate cover):*

Monthly: Billed at $50/month (plus initial fee of $100)Annual: Billed at $600/year
BILLING ADDRESS (if different from physical address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please indicate the UNITT Department(s) that you are interested in:

Business Registration & FinanceHealth, Social Services, & EducationAgricultureTransportationTribal Affairs (International & Domestic)Defense & SecurityTribal JusticeProductions & Media
Please read the following carefully:
Background Consent:*

I consent to Background Check using the information provided.
Click to agree to the following Terms & Conditions:*

All payments made through this system are non-refundable or transferrable. Application submission does not confirm membership into any Clan of the Association. Applications will be reviewed an approved by the Chief or Clan Mother listed on the form. Please allow up to 7 days for processing of your application. No payments will be charged prior to approval.
Declaration:

I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that membership approval is at the discretion of the association and may be subject to review.
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
OFFICIALS ONLY

This section to be completed by a Clan Official
APPLICATION STATUS
OFFICIAL'S NAME
Date

MonthDayYear
Date
Should be Empty:

Creek of Midwest Ta'Meri Membership Application--HOUSE EDWARDS

Please read the following carefully:

OFFICIALS ONLY