Membership

I consent to 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.

CONTACT INFORMATION

Title*
---MrMrsMsMiss

First Name*

Middle Name

Surname*

Maiden Name (if applicable)

Date of Birth*

Place of Birth

Street Address*

Suburb*

Postcode*

State*
---QLDNTWASAVICTASACTNSW

Postal Address

Phone Number

E-mail

APICAL ANCESTORS* (Please select only one apical ancestor. If you have multiple apical ancestors, please complete a new form for each one.)
Jinnegah aka Mary and Albert MurrayHarry RookwoodLizzie Woodford/Gyemore/SouthLucy of the Balonne RiverHarry Collins and Dinah SmithCharlotte MoffatOld FrogMary of BollonNellie WalkerClifton GeorgeKing Billy DickMaria of Tongy StationKate Meathers/MeadowsParents of Mary of the Maranoa and LizzieEffie Armstrong, the granddaughter of Coombra JackMaggie of the Moonie, the mother of Sarah Brennan and Isabella KerrKitty of St George aka Mary Bolon, the mother of George Hazzard Jnr aka Henry James Hazzard

FAMILY MEMBERS
Siblings

Children

Grandchildren

GUNGGARI DESCENT LINES (this information is about your Gunggari connection. Please only add information for people who are Gunggari and complete as far back as memory allows)

Gunggari Descent Line Information (Parent)*

Gunggari Descent Line Information (Grandparent)*

Gunggari Descent Line Information (Great Grandparent)






This great grandparent is an apical ancestor.

Gunggari Descent Line Information (Great Great Grandparent)






This great great grandparent is an apical ancestor.

Gunggari Descent Line Information (Great Great Great Grandparent)






This great great great grandparent is an apical ancestor.

I confirm that I am at least 18 years of age, a Native Title Holder and member of the Gunggari People, and I am applying for membership to the Gunggari Native Title Aboriginal Corporation ('the Corporation'). I confirm that 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.