PLEASE NOTE: You may copy and paste this application to your word processor for printing. You will need to send it to the address at the bottom via "snail mail" along with a small passport photo of the applicants. Thank you!

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APPLICATION FOR REGISTRATION
UNDER THE CITIZENSHIP CODE OF THE MÉTIS NATION IN NEW ENGLAND

APPLICANT

I request that I and my minor children, if eligible, be registered as Métis citizens, that our names be entered in the National Register, as provided under the Citizenship code of the Métis Nation in New England.

FAMILY NAME _________________________________________________________
GIVEN NAME __________________________________________________________
MAILING ADDRESS _____________________________________________________
TOWN _________________________STATE__________ZIP CODE_________
DATE OF BIRTH_____/_____/_____ S.S.N.________/________/___________
TELEPHONE : HOME_____/______/_________WORK______/_________/_________
EMAIL:__________________________________________

CHILDREN

If you have children under the age of 18, please list all their names and birth dates and attach a long form birth registration showing the names of the parents. Your children who have reached the age of 18 must complete a separate application and also provide a copy of their long form birth registration.

BIRTH DATE              FAMILY NAME                        GIVEN NAME
___/____/____ __________________________ _______________________
___/____/____ __________________________ _______________________
___/____/____ __________________________ _______________________
___/____/____ __________________________ _______________________

GENEALOGICAL REFERENCES

Please provide reference papers showing that your origins come from someone who is a Métis from North America OR someone who is a member of a First Nation in North America AND someone who is a member of one of the Nations of newcomers in North America.

LIST OF YOUR DOCUMENT OF REFERENCES
1.____________________________________________________________________
2.____________________________________________________________________
3.____________________________________________________________________
If your reference papers are not conclusive to demonstrate that you are Métis, you must include with your application for registration the Declaration of Métis identity and the Certification of Métis identity forms.

You must foward your application to the:

Secretariat of the Métis Nation in New England
PO Box 1013
Washington, NH 03280-1013

We will be please to provide you with a certificate of citizenship if you comply with the conditions requested by the Citizenship Code of the Métis Nation in New England. The Métis Nation in New England warn the applicant that The Nation will not be responsible of a false declaration submitted from falsified documents.

________________________________________ ______/______/_______
APPLICANT SIGNATURE                                                  DATE