Membership Application Form

Any other names that you may have been known by:

Address: (physical)

Postal Address

Place of Birth:

Date of Birth:

hereby apply for membership of the Butchulla Native Title Aboriginal Corporation (BNTAC) RNTBC.

Please nominate one (1) Family Group to which you belong to, this will be your Nominated Family Group under which you will be entitled to vote for the purpose of your membership: (please tick ✔)

I am the biological descendant of:

I advise that I am the child of: (name of parent/s)

I advise that I am the grandchild of:(name of grandparent/s)

I advise that I am the great grandchild of: (name of great grandparent/s)

My siblings are: (name/s of siblings)

My children are: (name/s of children)

My grandchildren are: (name/s of grandchildren)

Statement of Accuracy and Truthfulness
I,
confirm the following:

a) I am 18 years of age or older;

b) I am a Butchulla (Badtjala) person;

c) The information submitted in this application is true and correct to the best of my knowledge and I understand that any false statements may result in denial or revocation
of my membership with the Corporation;

d) That I consent for the Corporation using the information provided by me in this form for the purpose of making decisions relating to my membership application, and to update
and maintain the Corporation's genealogical and membership database, and for any other purpose at the discretion of the Corporation to assist the Corporation to perform its
functions and duties; and

e) That I agree to abide by the Rules of the Corporation and I agree to abide by any Code of Conduct adopted by the Corporation.