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Dec 13, 2017
Membership Form
NAFC Membership Form
Primary Contact Name (Please complete all contact fields)
*
Primary Contact Name (Please complete all contact fields)
First
First
Last
Last
Phone
*
Email
*
Preferred Contact Method
*
Call
Text
Email
Date of Birth (mm/dd/yyyy)
*
Preferred Pronouns
He/Him
She/Her
They/Them
Do you self identify as an Indigenous person? (Primary Contact)
Yes
No
Choose not to specify
If yes, please identify (as many as applicable)
First Nation
Inuit
Metis
Other
If you have selected "Other", please specify.
Spouse/Secondary Contact Name (Please complete all contact fields)
Spouse/Secondary Contact Name (Please complete all contact fields)
First
First
Last
Last
Secondary Contact Phone
Seondary Contact Email
Preferred Contact Method (Secondary Contact)
Call
Text
Email
Do you self identify as an Indigenous person? (Secondary Contact)
Yes
No
Choose not to specify
If yes, please identify (as many as applicable)
First Nation
Inuit
Metis
Other
If you have selected "Other", please specify.
Mailing Address (Street Number, Name)
*
City
*
Province
*
Postal Code
*
Physical Address, if different than above (Street Number, Name)
City
Province
Postal Code
Do you have children/grandchildren? (If yes, please provide the following information)
*
Yes
No
Children/Grandchildren Name (Under 18)
Children/Grandchildren Name (Under 18)
First
First
Last
Last
Date of Birth (mm/dd/yyyy)
Preferred Pronouns
He/Him
She/Her
They/Them
Does your child/grandchild self identify as an Indigenous person?
Yes
No
Choose not to specify
If yes, please identify (as many as applicable)
First Nation
Inuit
Metis
Other
If you have selected "Other", please specify.
Children/Grandchildren Name (Under 18)
Children/Grandchildren Name (Under 18)
First
First
Last
Last
Date of Birth (mm/dd/yyyy)
Preferred Pronouns
He/Him
She/Her
They/Them
Does your child/grandchild self identify as an Indigenous person?
Yes
No
Choose not to specify
If yes, please identify (as many as applicable)
First Nation
Inuit
Metis
Other
If you have selected "Other", please specify.
Children/Grandchildren Name (Under 18)
Children/Grandchildren Name (Under 18)
First
First
Last
Last
Date of Birth (mm/dd/yyyy)
Preferred Pronouns
He/Him
She/Her
They/Them
Does your child/grandchild self identify as an Indigenous person?
Yes
No
Choose not to specify
If yes, please identify (as many as applicable)
First Nation
Inuit
Metis
Other
If you have selected "Other", please specify.
Children/Grandchildren Name (Under 18)
Children/Grandchildren Name (Under 18)
First
First
Last
Last
Date of Birth (mm/dd/yyyy)
Preferred Pronouns
He/Him
She/Her
They/Them
Does your child/grandchild self identify as an Indigenous person?
Yes
No
Choose not to specify
If yes, please identify (as many as applicable)
First Nation
Inuit
Metis
Other
If you have selected "Other", please specify.
Would you like to be contacted if we have a program or service that may interest you?
*
Yes
No
If you are at the Centre or participating in a program we offer, do you approve of us sharing you photo?
*
Yes
No
Would you like to be added to our list of volunteers? (If yes, an NAFC Team Member will be in touch with you with further information)
*
Yes
No
Please let us know if there are any services you think we should offer that are not currently not available through our organization.
How did you hear about us? (Please check all that apply)
Already a member
Family or friends
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Other
If you have selected "Other", please specify.
Number
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