Full Legal Name *

Phone *

Email *

Date of birth

Gender *

Address

Street Address

City

State

Country

Postal code

Marital Status *

Linkedin Profile ?

Facebook URL ?

Instagram URL ?

TikTok URL?

Other Social Media Platforms ?

Number of Dependents (if applicable)

If applicable, please list all dependents under 18 that you wish to enroll as members. First and Last Name, Date of Birth, Sex, Interests, Educational Level, (for up to 6 children)

Dependent- Full Legal Name, Sex, Birthday, Education Level (Dependent 2)

Dependent- Full Legal Name, Sex, Birthday, Education Level (Dependent 3)

Dependent- Full Legal Name, Sex, Birthday, Education Level (Dependent 4)

Dependent- Full Legal Name, Sex, Birthday, Education Level (Dependent 5)

Dependent- Full Legal Name, Sex, Birthday, Education Level (Dependent 6)

What is your race? *

Are you okay with being referred to as Indigenous? *

How do you identify your cultural heritage?

What is your nationality? *

Have you ever held dual or multiple citizenship? Yes / No *

If yes, please specify which countries you are a citizen of.

What are your current or past professions or trades? *

Would you like to apply to government position?

Are you willing to volunteer or work toward the development of The Nation of Cherut?

Why do you want to become a member of The Nation of Cherut?

How do you see yourself contributing to the growth and sustainability of the nation?

What values or principles of The Nation of Cherut resonate with you the most?

Have you ever been convicted of a crime? *

If yes, please provide details:

Do you agree to abide by the laws, values, and principles of The Free and Independent Nation of Cherut?

A copy of a valid ID or passport. This is for identity and security purposes. Your membership card will reflect the information shown on your valid identification or passport (Upload)

Resume (optional but recommended. It is required if you plan to serve in government positions or to be considered for employment opportunities) Resume/CV Upload

Professional Headshot Upload (optional but encouraged)

Membership Oath:

I solemnly pledge my loyalty, dedication, and service to the Nation of Cherut, its Warrior Queen, and all its citizens. As a proud member of The Nation of Cherut, I vow to uphold the values of spirituality, self-determination, self-care, sustainability, and solidarity that define our nation. I will contribute to the growth and prosperity of our free and independent nation, respecting its laws, protecting its freedoms, and honoring its culture and traditions. With integrity and a steadfast spirit, I commit to fostering peace, moving with integrity, and serving my fellow citizens and our nation with honor and pride.

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