Membership Profile Information

Please complete all of the fields on this form. We will use this information to verify your profile and update it with the information you provide. Please note, if you would like to update your information with Indigenous Services Canada, call 1-800-561-2266.

First Name
Middle Name
Last Name
Band Number
Birth Date


Civic Address

Please start by selecting your country, and fill in the fields that follow.

Street Address
City
Province
State
Postal Code
Zip Code
International Civic Address
Country


Previous Community

If your current address is not in a ward, have you previously lived in a different Newfoundland community?

Previous Community Name


Mailing Address

Please enter your complete mailing address (P.O. Box, City, etc...) if it is different than your civic address.

Mailing Address

Contact Information

Please enter your contact information.

E-mail Address
Home Phone
Work Phone
Cell Phone