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Bluebird Youth Membership Registration
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Tribal Affiliation (list all that apply)
*
Your answer
Tribal Enrollment Status
*
Yes
No
Pending (Papers filed)
Unsure/ I don't know
Not eligible
Enrolled Tribe (if listed more then 1 affiliation above)
Your answer
Ethnicity/ Race
Mark ALL that apply
Native American/Alaskan Native
Hawaiian/Other Pacific Islander
Hispanic/Latino
Asian
White
Not Listed
Mark ALL that apply
Native American/Alaskan Native
Hawaiian/Other Pacific Islander
Hispanic/Latino
Asian
White
Not Listed
Primary Phone Number
*
Your answer
Youth's Email (if applicable)
Your answer
Address
*
Your answer
Grade in School
*
Your answer
School Attending
*
Your answer
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