Minangu Land Group Membership Application Form NAME:* FIRST NAME: MIDDLE NAME: SURNAME: GENDER* MALE FEMALE DATE OF BIRTH:*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920ADDRESS:* STREET: SUBURB: POSTCODE: POSTAL ADDRESS:If different from residential address. STREET: SUBURB: POSTCODE: EMAIL:* MOBILE:* ARE YOU A MEMBER OF WAJARRI YAMAJI ABORIGINAL CORPORATION RNTBC (WYAC)?* YES NO If no, then you must first become a member of WYAC before applying for Land Groupmembership. You can find the WYAC application form here.DO YOU HAVE IMMEDIATE FAMILY WHO ARE ALREADY MEMBERS OF MINANGU LAND GROUP?* YES NO IF YES PLEASE STATE THEIR NAME/S AND RELATIONSHIP: The details of my Wajarri Yamaji 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.1 2 3 4 5 6 7 8 9 10 11 12 13 14 My ChildrenPlease list the First Name, Surname and Date of Birth of you children.MY APICAL ANCESTOR IS:Please tick Amy Porter and Jigaroo Angelina (mother of Alice Darby) Badja and Kadjba (siblings) Baljarba (also known as Jim Crow) (married Badja) Billelia (also known as Nellie) (mother of Fred Simpson) Budjeeyona and Jinny Bunnabuddy (also known as Daisy) and Molly (siblings) Caroline (mother of Lena Sullivan) Charlie Dongara Coolya (also known as Judy) Dija Emily (mother of Lizzie Worth) English Edwards and Mary Jane (also known as Mununmarie) Eniwani Jimmy and Jenny (also known as Jinnie) Frances, Tiger, unnamed and Boomer Ryan (siblings) Frank Franklin (also known as Punch) Ivy, Robby and Simon Walgar (siblings) Jane Towser Jibija (also known as Rosie Jones) Jimmy and Judy Jinatharra (also known as Bobby Clark) Jinty (also known as Cindy Tyson nee Sullivan) Jubyjub (also known as Janie Narry) Julia (mother of Cecil Lane) Kia (also known as Murgoo Fred) Kitty Gilbert lnnie (also known as Annie) Mary from Twin Peaks Mogagee (also known as Daniel Dann) (married Annie) Molly (married unnamed Ryan) Moweramarra (also known as Caroline) (mother of Ruby Nairn) Nyuga and Isaac Polly (Mother of Paddy Donnelly) Polly Parker Rosie English (also known as Yangudgi) Tommy and Fanny Jones Tommy Glass Topsy (mother of Mary Wheelock) Wannanu (also known as Waurene Porter) William Jones and Sarah Yanbaree Wajarri Yamaji 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 Yamaji; (b) identify themselves as Wajarri Yamaji in accordance with the traditional laws acknowledged and the traditional customs observed by the Wajarri Yamaji; and (c) are accepted as Wajarri Yamaji in accordance with the traditional laws acknowledged and the traditional customs observed by the Wajarri Yamaji." MEMBERSHIP RESPONSIBILITIES*I agree to carry out the following responsibilities as a Member of Wajarri Yamaji Aboriginal Corporation and Minangu Land Group as required by Clause 5.5.2 of the Wajarri Yamaji Aboriginal Corporation 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, the Land Committee and the Directors with respect and dignity. (e) to not behave in a way that significantly interferes with the operation of the Land Group or of Land Group meetings or Land Committee 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 Yamaji Person and identify specifically with the Minangu Land Group TO ACCEPT, TYPE YOUR NAME BELOW*For any application enquiries please contact the office on 08 9997 3444 or email members@wajarri.com.au