Current Member
For members to be included on members correspondence.
Email address *
First Name *
Your answer
Middle Initial *
Your answer
Last Name *
Your answer
Maiden Name *
Your answer
Chitimacha Descendants (List 4-5 Generations) *
Your answer
Phone Number *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
ZIP Code *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Are you state or federally recognized by an Indian tribe? *
If yes, which tribe? (N/A if no) *
Your answer
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: *
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