WICOCOMICO INDIAN NATION
SIERRA VISTA, ARIZONA
85635

APPLICATION
EFFECTIVE IMMEDIATELY APPLICATIONS ARE NO LONGER BEING ACCEPTED...SEE MAIN PAGE CONCERNING THE STATUS OF THE WICOCOMICO INDIAN NATION.

I hereby request membership in the Wicocomico Indian Nation, based on lineage from the Wicocomico Indians or William Taptico, John Veazey, or other proven Wicocomico family names. Attach a copy of your lineage with your application.The family tree chart is acceptable. The chart must be typed or completed with a word processor. The applicant must enclose an annual membership fee of $32 for five months or $160 for lifetime membership. A payment plan is available.

By accepting membership in the Wicocomico Indian Nation, I agree and understand that all research material conducted by and for the Wicocomico Indian Nation is the sole ownership of the Wicocomico Indian Nation Inc. and is copyrighted in accordance with existing federal laws. I understand that being a member of the Wicocomico Indian Nation does not give me benefits or ownership in the Tribal Government or Corporation. I also understand that recognition by the Federal Government is not guaranteed.

I also understand and agree to return all ID cards and certificates to the Wicocomico Tribal Government in the event that I resign or removed from the Tribal Rolls for reason. [Initial________].

After acceptance, the applicant will be placed on the Tribal Membership Rolls. If the applicant is not accepted based on incorrect lineage, their membership fees will be returned.

The following applicant information is required for entry on the Tribal Rolls.

I______________________________confirm the enclosed information is true and correct to the best of my knowledge.

Please complete all the information.If the information is not complete or unclear, membership enrollment will be delayed.

Print Full Name:_______________________________________

Signature:____________________________________________

Address:_________________________________Zip__________

______________________________________________________

______________________________________________________.

Telephone:________________________Email:______________

Date of Birth________________Place of Birth______________

Maiden Name of Married Women________________________

Name of Father________________________________________

Maiden Name of Mother________________________________

Are you currently a member of another tribe ?Yes____No____

If yes, the name of the tribe.______________________________

Is your Father or Mother a member of another tribe?Yes_No_

If yes,the name of the tribe._______________________________

By accepting membership in the Wicocomico Tribe, I agree to maintain contact with my regional representative or the Weroance monthly,
failure to do so is reason to be removed from the tribal rolls.I also agree that if for reason or resignation, I leave the tribe,
my name may be posted on the web site as no longer being a member of the tribe; addresses or phone numbers will not be posted.

Date____________________.[Initial_________]

FOR TRIBAL GOVERNMENT USE

COMMENTS

APPROVED_____ENROLLMENT NUMBER__________

DISAPPROVED________REASON___________________

WEROANCE_____________________________________

DATE___________________________________________

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© Al Byrd, Feb.2003