Central Council Tlingit and Haida Indian Tribes of Alaska
Delegate Election
Declaration of Intent to Serve
I, , am declaring Candidacy for Central Council
Tlingit and Haida Indian Tribes of Alaska.
Date of Birth Enrollment Number Email Address
Mailing Address City
State Zip
Residence Address City
State Zip
Primary Phone Number Cell Number
I am requesting my name be listed on the ballot as follows:
Last Name First Name MI Nickname and/or Suffix
I am declaring my candidacy for delegate to the Tribal Assembly of the Central Council
of the Tlingit and Haida Indian Tribes of Alaska and if I am elected I intend to serve for
the duration of the term for which I am elected. Please place my name on the ballot as it
appears above.
Signature Date