New member:
Renewal:
Family name:
Name:
Address:
City:
Province:
Postal code:
Telephone:
Fax:
Email:
Nation:
Band number: (according to the Indian Act, chapter 27)
Community:
Age group:	16-29 30-39 40-49 50-59 60+
Language:	English Français
Local President:
Nation director:

Payment:		I have mailed the $5 payment to QNW.
		I have paid the $5 fee to my local president.
		I have paid the $5 fee to my Nation's director.

Fields of interest:

Shortly after you submit this completed form, you will receive an
e-mail confirming whether we received your membership form.
Please note that all new membership applications are subject to approval by their Nation Director or by QNW's Board of Directors.

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