Cherokee Nation Seal CHEROKEE NATION
Registration Department
P.O. Box 948
Tahlequah, OK 74465
Application for Membership in the Cherokee Nation

(PLEASE PRINT IN INK)

______________________ _________________ _________________ _________________
LAST NAME FIRST MIDDLE MAIDEN
DATE OF BIRTH ________/ ________/ ________ MALE  FEMALE ____________________
MO. DAY YEAR SOCIAL SECURITY NUMBER
______________________________________ ________________ _________________ _____________
MAILING ADDRESS (NUMBER, STREET, ROUTE, BOX) CITY STATE ZIP

Are you a registered member of any other Tribe? YES  NO Tribe:_____________________________

Have you registered as a member of the Cherokee Nation before? YES  NO
When?_______________________________ Registration Number? ___________________________
 

Please attach a "COPY" of the Certificate of Degree on Indian Blood (CDIB) Card to the application. NO MEMBERSHIP CARD WILL BE ISSUED UNTIL CERTIFICATION IS AVAILABLE FROM THE BIA.

Check the county where you reside:

Adair Muskogee Wagoner
Cherokee Nowata Washington
Craig Ottawa All Other Oklahoma
Delaware Rogers Out of State
Mayes Sequoyah Out of Country
McIntosh Tulsa

 
________________________________________ ________________________________________
Date of Signature Signature of Applicant (IN INK)
DO NOT WRITE BELOW THIS LINE
CHEROKEE REGISTRY NUMBER
APPROVED  DISAPPROVED
REASON: _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
REG FORM-M1(3/91) ____________________________________ ______________________
Registrar: Date