Fillable OFFICIAL DELEGATE REGISTRATION FORM

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OFFICIAL DELEGATE REGISTRATION FORM

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Official Delegate Registration Form (Page 1 of 2)
Please check appropriate box:
Regional Corporation Regional Nonprot Association
Village Corporation IRA/Traditional Council
Print clearly:
Organization Name:
Mailing Address:
City/Village: State: Zip:
Email and Website:
Telephone: Fax:
This certifies that the above organization did, in its regular business meeting, appoint the following
individual(s) to serve as its Official Delegate(s) to the Alaska Federation of Natives Annual
Convention to be held on October 21, 22 & 23, 2021 at the Dena'ina Center in Anchorage, AK.
To register, each delegate needs to submit the following information:
Submit extra forms attached to this one if you need more space for delegate registration (*indicates
required).
* Full Name:
* Email:
* Full Name:
* Email:
* Full Name:
* Email:
* Full Name:
* Email:
* Full Name:
* Email:
OFFICIAL DELEGATE REGISTRATION FORM
* Full Name:
* Email:
* Full Name:
* Email:
* Full Name:
* Email:
* Full Name:
* Email:
* Full Name:
* Email:
* Full Name:
* Email:
* Full Name:
* Email:
Official Representative & Title:
Name (please print) Title
Signature Date
MAIL OR EMAIL THIS FORM TO:
Alaska Federation of Natives
3000 A Street, Suite 210 | Anchorage, Alaska 99503
Phone: (907) 274-3611 | Fax: (907) 276-7989 | www.nativefederation.org | delegate@nativefederation.org
Official Delegate Registration Form (Page 2 of 2)
OFFICIAL DELEGATE REGISTRATION FORM
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OFFICIAL DELEGATE REGISTRATION FORM

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Completed 31 August 2021

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