Enrollment Form for the Una Tribe of Mixed-Bloods

Do you have at least one Native American Ancestor and consider yourself a Mixed-Blood?
- Yes
- No
What is your ancestral Native American Tribe? Feel free to fill-in multiple; separate each one by a common. If you do not know, please write "N/A'
First Name
Middle Initial
Last Name
What is your birthdate?
Birth Place (Example: New York, USA)
Fathers Full Name
Mothers (Pre-Marital) Full Name
Current Address
Phone Number (real working number)
Email Address
Your Spouses First Name
Spouses Last name
Spouses Birthdate
Is your spouse Mixed-Blood?
- Yes
- No
- There is a chance
List your children, including their birthdates (if you do not have a child, please input N/A)
List your grandchildren, including their birthdates (if you do not have a grandchild child, please input N/A). If there is no one else, please input N/A
Please list all other family members you are enrolling (siblings, nieces, nephews, great-grandchildren, etc.)
Please write out your full name to state that you understand that all information given within the application shall be solely for tribal purposes.
Please describe how you are of Native American descent.
Why do you want to become an enrolled member of the Una Nation of Mixed-Bloods?
Any Comments or Notes.
Would you like to be considered for the position of Senator within the Una National Senate, to better represent our people?
- Yes
- No
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Una Nation of Mixed-Bloods