Membership Application Form NAME:* FIRST NAME: MIDDLE NAME: SURNAME: GENDER*MALEFEMALEDATE OF BIRTH:*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920ADDRESS:* STREET: SUBURB: POSTCODE: POSTAL ADDRESS:If different from residential address. STREET: SUBURB: POSTCODE: EMAIL:* MOBILE:*ARE YOU A MEMBER OF ANY OTHER NATIVE TITLE CLAIM GROUP?*YESNOIF YES PLEASE SPECIFY WHICH OTHER GROUP(S):WHAT IS YOUR PRIMARY LAND GROUP?*BYROBURRINGURRAHNOONGNOOROOMEENANGUDO YOU HAVE A SECONDARY LAND GROUP?*YESNOIF YES PLEASE STATE SECONDARY LAND GROUP?WHAT IS YOUR WAJARRI YAMATJI AREA?LOWER MURCHISON - REMAINING AREASDO YOU HAVE ANY IMMEDIATE FAMILY WHO IS ALREADY A MEMBER OF MWAC?*YESNOIF YES PLEASE STATE THEIR NAMES AND RELATIONSHIP:The details of my Wajarri Yamatji connection are: Please fill out this section to the best of your knowledge. We understand there may be times where some information may be unavailable. The more information that can be provided makes it easier for your application to be assessed. Using the diagram above for reference, please fill the numbered fields below.1234567891011121314My ChildrenPlease list the First Name, Surname and Date of Birth of you children.MY APICAL ANCESTOR IS:Please tick Kia (also known as Murgoo Fred) lnnie (also known as Annie) Rosie English (also known as Yangudgi) Badja and Kadjba (siblings) Baljarba (also known as Jim Crow) (married Badja) Mogagee (also known as Daniel Dann) (married Annie) Jinatharra (also known as Bobby Clark) Tommy Glass Wannanu (also known as Waurene Porter) Billelia (also known as Nellie) (mother of Fred Simpson) English Edwards and Mary Jane (also known as Mununmarie) Yanbaree Kitty Gilbert Dija Mary from Twin Peaks Emily (mother of Lizzie Worth) Ivy, Robby and Simon Walgar (siblings) Tommy and Fanny Jones Frances, Tiger, unnamed and Boomer Ryan (siblings) Molly (married unnamed Ryan) Caroline (mother of Lena Sullivan) Budjeeyona and Jinny Jinty (also known as Cindy Tyson nee Sullivan) Amy Porter and Jigaroo Polly Parker Frank Franklin (also known as Punch) Charlie Dongara Eniwani Jimmy and Jenny (also known as Jinnie) William Jones and Sarah Julia (mother of Cecil Lane) Jimmy and Judy Bunnabuddy (also known as Daisy) and Molly (siblings) Jibija (also known as Rosie Jones) Moweramarra (also known as Caroline) (mother of Ruby Nairn) Nyuga and Isaac Jane Towser Coolya (also known as Judy) Jubyjub (also known as Janie Narry) Wajarri Yamatji People means those persons who: (a) Are descended from one or more of the above ancestors "where descent can be either by birth or adoption in accordance with the traditional laws acknowledged and the traditional customs observed by the Wajarri Yamatji; (b) identify themselves as Wajarri Yamatji in accordance with the traditional laws acknowledged and the traditional customs observed by the Wajarri Yamatji; and (c) are accepted as Wajarri Yamatji in accordance with the traditional laws acknowledged and the traditional customs observed by the Wajarri Yamatji."MEMBERSHIP RESPONSIBILITIES*I agree to carry out the following responsibilities as a Member as required by Clause 6.4.2 of the MWAC Rule Book: (a) to comply with the CATSI ACT and the Rule Book (b) to notify the Corporation of any change to my address within 28 days (c) to comply with any Code of Conduct adopted by the members (d) to treat other Members and the Directors with respect and dignity. (e) to not behave in a way that significantly interferes with the operation of the Corporation or of Board meetings or General Meetings I agree to carry out my responsibilities as a Member of the Corporation Application DeclarationI declare that I am eligible to apply as a Member, according to the following requirements: • I am 18 years old or over; and • I am a Wajarri Yamatji Person TO ACCEPT, TYPE YOUR NAME BELOW*For any application enquiries please contact the office on 08 9997 3444 or email members@wajarri.com.au