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: ________________________________________________________________
