Name

First Name

Last Name

Phone

(###)

###

####

I wish to apply to become a member of the Homeland School Company. Upon becoming a member I agree: 1) to $10 being the amount of my guarantee and 2) Being bound by the Constitution of the Company.

Yes

Please send any notices to:

Phone

Email

Postal Address

I declare that I am eligible for membership as an Aboriginal person over 18 years of age who has a recognised connection to one or more of the clans and their country within the Maningrida region through one or more of the following relationships or another recognised traditional affiliation.

Yes

Date

MM

DD

YYYY