Application for Membership in the Cherokee Nation

CHEROKEE NATION
Registration Department
P.O. Box 948
Tahlequah, OK 74465

Application for Membership in the Cherokee Nation

(PLEASE PRINT IN INK)

______________________	_________________	_________________	_________________
LAST NAME	FIRST	MIDDLE	MAIDEN

DATE OF BIRTH	________/	________/	________	MALE FEMALE	____________________
	MO.	DAY	YEAR		SOCIAL SECURITY NUMBER

______________________________________	________________	_________________	_____________
MAILING ADDRESS (NUMBER, STREET, ROUTE, BOX)	CITY	STATE	ZIP

Are you a registered member of any other Tribe? YES NO Tribe:_____________________________

Have you registered as a member of the Cherokee Nation before? YES NO
When?_______________________________ Registration Number? ___________________________

Please attach a "COPY" of the Certificate of Degree on Indian Blood (CDIB) Card to the application. NO MEMBERSHIP CARD WILL BE ISSUED UNTIL CERTIFICATION IS AVAILABLE FROM THE BIA.

Check the county where you reside:

Adair	Muskogee	Wagoner
Cherokee	Nowata	Washington
Craig	Ottowa	All Other Oklahoma
Delaware	Rogers	Out of State
Mayes	Sequoyah	Out of Country
McIntosh	Tulsa

________________________________________	________________________________________
Date of Signature	Signature of Applicant (IN INK)

DO NOT WRITE BELOW THIS LINE

CHEROKEE REGISTRY NUMBER

APPROVED DISAPPROVED

REASON:	_____________________________________________________________________
	_____________________________________________________________________
	_____________________________________________________________________

REG FORM-M1(3/91)	____________________________________	______________________
	Registrar:	Date