MMF Metis Harvester Identification Card Application Form

METIS HARVESTER IDENTIFICATION CARD APPLICATION FORM
This Application Form is four pages in length and includes General Information, Declaration for
Metis Harvester Identification Card, and Authorization for Information sections.
General Information Section
Name in Full (Please print in block letters):
Surname First Name Middle Name Maiden Name
(If applicable)
Address: ______________________ City/Town: _____________ Postal Code: __________
Telephone #: (H) _____________ (W) _____________ Other ____________________
Date of Birth: ____________________ Place of Birth: ______________________________
Gender: ________________ Height: _____________ Eye Colour: ____________
MMF Membership Number #____________________. (If applicant is holder of MMF voting
membership number).
Member of _____________________________ Local of the MMF _________________Region
Father’s Name: ________________________________________________________________
Surname First Name Middle Name
Mother’s Name: _______________________________________________________________
Maiden Name First Name Middle Name
Spouse’s Name: _______________________________________________________________
Maiden Name First Name Middle Name
Children under 18 years of age:
MANITOBA METIS FEDERATION INC.
300-150 Henry Avenue
Winnipeg, Manitoba
R3B 0J7
Phone: (204) 586-8474
Fax: (204) 947-1816
Website: www.mmf.mb.ca
Name Date of Birth Place of Birth
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