Membership

Sign up to be a member of MIA

First Name:
Last Name:
Address (or PO Box):
City/Community:
Province/Territory: Postal Code:
Phone Number (preferred):
Phone Number (work):
Phone Number (cell):
E-mail Address:
 
Are you Inuit?
Have you lived in Manitoba for over 3 months?
Are you 16 or older?
What is your birth date (mm/dd/yyyy)?
  
 
If you are associated with an Inuit Land Claim region, please check off the appropriate Inuit Land Claim region:



 
Talents:


Add Other Talent

 
Do you wish to be contacted to run for the board of MIA?
Comments?
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