— GET INVOLVED —

Update Your Information

Update your contact information today by filling out the form below.

Completely fill in each section.
If updating address, include proof of address (i.e., driver’s license, bill, etc.)
Date the bottom of this application.
Applications and attachments can be emailed or mailed to the
Indigenous Congress of Alberta Association
Suite #339, 11045-156 Street NW, Edmonton, AB T5P 2P7
Leanne Willier, Community Liaison
E: membership@indigenouscongress.com
P: 780-699-1478

Name

First Name

Last Name

Member Number

(As listed on your membership card)

Newest/Current Mailing Address

(or PO Box, if applicable)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Newest/Current Home Address

(If different to mailing address)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Newest/Current Email

Newest/Current Phone Number

(###)

###

####

List umber of Dependants (under 18 years olds)

List Ages of Dependants (under 18 years old)

Date of Application

YYYY

Attachments

Check off one of the following. Note: address updates will be considered incomplete without the submission of relevant attachments.

I am updating my address, and I will be mailing my proof of mailing address, to Unit 201D, 11051 97 Street NW, Edmonton, AB, T5H 2N2.

I am updating my address, and I will be emailing my proof of mailing address to membership@indigenouscongress.com.