Current Member
For members to be included on members correspondence.
Email address *
First Name *
Middle Initial *
Last Name *
Maiden Name *
Chitimacha Descendants (List 4-5 Generations) *
Phone Number *
Street Address *
City *
State *
ZIP Code *
Date of Birth *
MM
/
DD
/
YYYY
Are you state or federally recognized by an Indian tribe? *
If yes, which tribe? (N/A if no) *
The information provided may be included in federal litigation. The code section criminalizing false statements to the federal government can be found under 18 U. S. C. §1001. To ensure the validity of the information collected, please check to confirm the following statement: *
Required
A copy of your responses will be emailed to the address you provided.
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