Kitsumkalum Treaty Enrolment Application Form for Band Members with Band/Status Number
Enrolment to Vote on the Kitsumkalum Treaty and Constitution 

If you are an Indigenous person that wants to vote on the Kitsumkalum Constitution
and the Kitsumkalum Treaty you must be registered to do so. To register, you need to
complete one of the following Enrolment Applications and meet the Enrolment Criteria
outlined within the application:

Application 1: Kitsumkalum Treaty Enrolment Application Form for Band Members with
Band/Status Number

Registering to vote does not mean acceptance of the Constitution and Treaty, but
rather, it means you will be able to vote on the Constitution and Treaty when the vote
takes place, to accept or not.

Currently, it is anticipated that voting will take place late fall 2025.

Applications:
 Download and print the application form or pick up a copy from the Treaty Office.
 Complete the application.
 Turn the completed application in at the Treaty Office to the attention of Bruce
Low, Eligibility and Enrolment Coordinator.
If you have any questions regarding this process, or you require assistance in
completing the application, please contact Bruce Low, Eligibility and Enrolment
Coordinator at 250-641-3111 or Bruce.Low@myself.com.

1.1. This Enrolment Application is for all applicants that are current Band Members with a
Band/Status number, for the Kitsumkalum Constitution and Treaty votes.
1.2. The information you provide in this application will be used to determine your eligibility
(Eligibility Criteria page 4) to be enrolled in the Kitsumkalum Treaty.
1.3. It is your responsibility to demonstrate that you meet the Enrolment criteria as set out in
the draft Kitsumkalum Constitution and Treaty.
1.4. Your application will be reviewed by the Kitsumkalum Eligibility and Enrolment Coordinator
for completeness and assessed by the Kitsumkalum Enrolment Committee.
1.5. It is your responsibility to keep the Eligibility and Enrolment Coordinator informed of your
current address, contact information and any changes to your personal information.
1.6. Please complete an application form for each applicant – adults, minor children, and
dependent adults for whom you are the legal guardian.
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Email *
2. APPLICANT PERSONAL INFORMATION

2.1. Applicant Full Name
 *
2.2. Date of Birth *
MM
/
DD
/
YYYY
2.3. Address: 
Street:
City:
Province/State:
Country:
Postal Code/Zip 
 *
Contact Information:
Cell Phone:
Home Phone:
Work Phone:
Email Address:
 *
3. Eligibility Confirmation:
I am currently on the Kitsumkalum Band List under the following Band/Status Number:
 *
Required
3.1. Status Number: *
4. DECLARATION FOR APPLICANT 

I,____________________ solemnly  declare that I am applying for enrolment in the Kitsumkalum Treaty, and the facts contained in this application are to the best of my knowledge true.
Further, to determine my eligibility for Kitsumkalum First Nation membership, I authorize Canada, BC, or any First Nation band or treaty nation, to share any relevant information in support of my application.

Official Notice: The intentional act of swearing a false oath or falsifying your affirmation to tell the truth, whether spoken or in writing, concerning matters material to your application will result in denial of your request for membership with Kitsumkalum First Nation.

Applicant Signature:
Date:
Witness Signature:
Witness Contact Information:

Note: Witness must be the Eligibility and Enrolment Coordinator, any Kitsumkalum Band member, or any person eligible for enrolment with Kitsumkalum First Nation.

The information provided in this application will be used to fulfill the requirements of enrolment of Kitsumkalum First Nations members to vote for the treaty. If you have any questions about the collection or use of this information, please contact the Eligibility and Enrolment Coordinator.
*Confidential when completed.
 *
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