Unified Indigenous Nation Enrollment Form

As a verified descendant of at least one of the Five Freedmen Nations you can now enroll in all nations for which you have a CDIH (Certificate of Degree of Indian Heritage) card.  Although you can hold citizenship in any and all nations you can only hold voting rights in one.

Please provide a copy of each CDIH card(s)  with your Application, you must designate your voting Nation.  Also requesting any copies of your Ancestor's Citizenship certificates. (for BIA purposes only)

Check all that apply:
(  ﴿ Choctaw  ﴾  ﴿ Chickasaw  ﴾  ﴿ Creek  ﴾  ﴿ Cherokee  ﴾  ﴿ Seminole
Please designate your voting rights nation: Check ONLY ONE
(  ﴿ Choctaw  ﴾  ﴿ Chickasaw  ﴾  ﴿ Creek  ﴾  ﴿ Cherokee  ﴾  ﴿ Seminole
Name____________________________________________________
Address__________________________________________________
_________________________________________________________
Phone Number_____________________________________________
Email Address_____________________________________________
PLEASE provide a photo READY with your application should you wish it to be placed on your registration card include 10.00 processing fee.
Amended forms (marriage) or reissue do to lost include 10.00 processing fee

Signature_______________________________________________________________

(A Must to complete enrollment) Social Security Number______________________________________________

Return All Applications to the registering agent
FD5CT, Inc.
9819 Locust, #6
Kansas City, Missouri 64131
May take up to 6 months for processing

EFFECTIVE JUNE 15, 2008 PHOTO READY PHOTO'S (NO COPIES OF PHOTOS) WILL BE MANDATORY INCLUDE A 10.00 PROCESSING FEE

Indigenous Cherokee Nation-Chief Robert “PathFinder” Miller
Indigenous Chickasaw Nation- Lenise Jamierson, Lead Council with the aid of Chief Running Deer
Indigenous Choctaw Nation-Chief Edward "Running Deer" Wyatt.
Indigenous Seminole Nation-Chief Bobby Gean "Fire Walker" Stinson
Indigenous Creek Nation- Under leadership of Clan's Mother Gypsy Ohoyo
Date__________________________