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Pueblo Friendship Powwow Association

Membership Application
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Pueblo Friendship Powwow Association

P.O. Box 42   Pueblo, CO   81002

(Please print clearly or type the following information)

 

Name: __________________________________________________________________________

 

Address: ________________________________________________________________________

                        (Number) Street                         P.O. Box                     Apt#

City: ____________________  State: __________   Zip: ________

Telephone: (h) _______-______-_______      ______-_______-______

Email address: _______________________________________________

 

Tribe Affliliation(s) ____________________________           DOB_______/_______/_____ (M)___(F)_____

Full blood ________________ Half Blood _________

Quarter blood _______1/8 or less _______

 

Type of Membership applying for:

Native American Individual:____________________  $12.00 per year

Non Native American/Associate Individual ______________$12.00 per year

Auxiliary Member Individual: ________________$24.00 per year

 

Junior Native American (Members under 18 years of age)

            Name: ________________________   (M)_____(F)_____   

                       DOB_____/_____/______

            Name: ________________________   (M)_____ (F)_____

                       DOB_____/_____/______

 

Junior Associate (Members under 18 years of age)

            Name: ________________________   (M)_____ (F)_____         

                       DOB_____/_____/______

            Name: ________________________   (M)_____ (F)_____           

                       DOB_____/_____/______

 

Why do you wish to become a member of this Association?

_____________________________________________________

_____________________________________________________

_____________________________________________________

Are you an active member of the military?  _______ yes _______ no

Are you a veteran?                                    _______ yes _______ no

 

Date of application: ______/______/______                                       

Date approved: ______/______/_______

 

Name of Sponsor: __________________________________________________________________

Applicant Signature: ________________________________________________________________

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P.O. Box 42, Pueblo, CO 81002