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Tlingit and Haida Indian Tribes o f Alaska (Central Council Tlingit and Haida Indian Tribes of Alaska)

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U.S.A. forms for Central Council Tlingit and Haida Indian Tribes of Alaska

BROWSE CENTRAL COUNCIL TLINGIT AND HAIDA INDIAN TRIBES OF ALASKA (AK) FORMS

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Rev. 4.25.18
CENTRAL COUNCIL
Tlingit and
Haida Indian Tribes o
f Alaska
Business & Economic Devel
opment Dept. • Edward K. Thomas Building
9097 Glacier Hwy • Juneau, Alaska 99801
Certified Tribal Artist Application
In order to apply for certification under Central Council of Tlingit and Haida Indian Tribes of Alaska’s (Tlingit &
Haida) Certified Tribal Artist program, eligible tribally-enrolled citizens must submit the following information:
☐ Completed Application with Terms of Agreement (Required)
☐ Copy of Tribal Enrollment Card OR ☐ Copy of Photo Identification (Required)
☐ $20 Processing Fee Payment (covers cost for starter gift tags/stickers and postage) (Required)
☐ Media Consent Form (Optional)
Applications will be reviewed within 30 days of receipt. Incomplete applications will not be accepted.
All documents and fee payments will be returned to ineligible applicants. Eligible applicants will be
issued a certificate, permit card, and 100 gift tags, stickers, or combination thereof to promote and
marke
t tribal citizen artwork. Additional gift tags or stickers can be purchased at $10.00 per 100 gift
tags/sticker
________________________________ ___________________________ ______________________
Artist Name Daytime/Evening Phone Number Fax Number
________________________________ ______________________________________________________
Mailing Address City State Zip
________________________________ ___________________________ ______________________
E-mail Address Name of Tribe Tribal Enrollment Number
________________________________ ___________________________ ______________________
Business Name Name on Business License License Number
________________________________ _____________________________________________________
Artist Website Social Media Site(s) FB, Twitter, Instagram, etc.
Type of Art:
☐ Basketry
☐ Beadwork
☐ Clothing
☐ Chilkat / Ravenstail
☐ Ivory, Bone, or Stone
☐Carving
☐ Jewelry
☐ Medicinal Products
☐ Metal Works/Sculpture
☐ Painting, Prints, or Cards
☐ Totem Poles
☐ Wood Carvings
☐ Other
_____________________
Please include payment information:
☐ Check / Money Order
☐ Credit/Debit Card ________ - _____
__ - ______-________ Expiration Date: ____ / ____ CVS ____
Submit Application To:
Business & Economic Development Department
9097 Glacier Hwy • Juneau, Alaska 99801
Toll: 1.800.344.1432 ext. 7139 • Direct: 907.463.7139 • Fax 888.322.6407 • Email: deptbed@ccthita-nsn.gov
CENTRAL COUNCIL
Tlingit and Haida Indian Tribes of Alaska
Business & Economic Development Dept. • Edward K. Thomas Building
9097 Glacier Hwy • Juneau, Alaska 9980
1
Rev. 04.25.18
C
ertified Tribal Artist
Terms of Agreement
I, the undersigned, certify I am Alaska Native, an enrolled tribal citizen of the Central Council Tlingit and Haida
Indian Tribes of Alaska, and at least 18 years of age.
I agree to only affix the Certified Tribal Artist seal, which features a Tináa with Eagle/Raven design embedded
within the shield and the words “Certified Tribal Artist,” to original art that has been or will be made entirely
by me.
I agree to follow the Indian Arts and Crafts Act of 1990 (P.L. 101-644 as amended); (18 U.S.C. 1159, 25 U.S.C
305 et seq.); 36 CFR 51 Truth-In-Marketing; 25CFR Part 309-Protection of Indian Arts and Crafts Products; U.S.
Fish and Wildlife Acts (Migratory Bird Treaty Act, Bald and Golden Eagle Protection Act, Marine Mammal
Protection Act, Endangered Species Act and Lacey Act) in accordance with State and Federal laws.
I have read the information and agree to abide by the Certified Tribal Artist program requirements as
described above and will not reproduce in any form the copy righted Certified Tribal Artist seal.
I certify the items listed above meet the “authentic Indian arts and crafts” and “Indian product” criteria (unless
otherwise noted), and are labeled appropriately as authentic in compliance with 36 CFR 51 Truth-In Marketing
laws concerning Native American/Alaska Native arts and crafts.
__________________________________________ _________________________
Artist Name (Print) Date
__________________________________________
Artist Signature
Internal Use Only
Date Received
Enrollment Verified
Certificate Number
Finance
Packet Mailed
Directory
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CENTRAL COUNCIL
Tlingit and Haida Indian Tribes of Alaska
Business & Economic Development Dept. • Edward K. Thomas
Building
9097 Glacier Hwy • Juneau, Alaska 99801
Rev. 04.25.18
Media Consent
I, the undersigned authorize the Central Council of the Tlingit and Haida Indian Tribes of Alaska
(Tlingit & Haida) to use, display, publish, and/or distribute my name, picture, portrait, likeness or voice
in any publication, multimedia production, display, advertisement or World-Wide Web Publication,
without limitation as to time.
I understand that the photographs, audio recordings, negatives and/or videotapes, if used, will be for
informational/educational purposes of Tlingit & Haida and I waive any right to inspect or approve the
finished photos and/or advertising copy. All photographs, audio recordings, negatives and/or
videotapes shall constitute the sole property of Tlingit & Haida. I declare that I am of legal age and
have every right to contract in my own name in the above regard.
I, the undersigned hereby waive all rights or claims for compensation in connection with the use of my
name, picture, portrait, likeness or voice, or any or all of them in any publication, multimedia
production, display, advertisement or World-Wide Web Publication, without limitation as to time; in
whole or in edited form and any use to which the same or any material therein may be put, applied or
adapted by Tlingit & Haida. In signing this waiver I acknowledge that Tlingit & Haida, its agents,
officers and employees are released from any and all claims and demands arising out of or in
connection with the use of said photographs/images, including but not limited to, any claims for
invasion of privacy or defamation.
Accepted and Agreed:
___________________________________________
Signature of Subject (Parents’ signature for youth under 18) Date
___________________________________________
Printed Name Daytime Phone #
___________________________________________
Mailing Address
___________________________________________
Signature of Witness Date
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Completed 20 July 2020

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