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Get Choctaw Tribal Membership Form

Application for Tribal Membership/Voters Registration Choctaw Nation of Oklahoma P. O. Box 1210 Durant OK 74702 Phone 580 924-8280 or 800 522-6170 Fax 580 924-4529 Name please print First Middle Last Maiden Address Street P. O. Box City State ZIP Code County Phone Number Birthday Sex Social Security Number Must be provided I CERTIFY THAT THE INFORMATION GIVEN IN THIS APPLICATION IS TRUE* I AM NOT A MEMBER OF ANOTHER TRIBE NOR AM I REGISTERED TO VOTE WITH ANOTHER TRIBE* Signature Date Please complete one for ALL minors. Under 16 years of age parent will need to sign* 16 years and older need to sign for themselves. Once you reach the age of 18 years you can vote. IF YOU LIVE OUTSIDE OF THE CHOCTAW NATION OF OKLAHOMA YOU MAY AFFILIATE WITH ONE OF THE DISTRICTS BELOW* ONCE YOU AFFILIATE YOU MUST REMAIN IN THE DISTRICT YOU HAVE CHOSEN* Residents Residents of the Choctaw Nation ten and one-half counties will be registered in the precinct in the county in which they reside. Absentee voting will be allowed by written request to the Election Board Chairman prior to an election or referendum* Non-Residents Applicants residing outside the Choctaw Nation will be registered to vote by mail* Do you want your name and address released to the general public Yes No PLEASE CHECK THE PROPER DISTRICT AND PRECINCT. District 1 Idabel Valliant Broken Bow Bethel Burkhart Smithville Talihina Heavener Poteau Spiro Summerfield Antlers Choctaw Council House Rattan Wright City Stigler Kinta Keota Hugo Boswell Fort Towson Buffalo Red Oak Wilburton Quinton For Office Use Only Date Approved or Disapproved Bennington Durant Calera Atoka Kiowa Stringtown Caddo Lane Hartshorne McAlester Coalgate Canadian Atwood Tupelo Arpelar Reason for disapproval. O. Box City State ZIP Code County Phone Number Birthday Sex Social Security Number Must be provided I CERTIFY THAT THE INFORMATION GIVEN IN THIS APPLICATION IS TRUE* I AM NOT A MEMBER OF ANOTHER TRIBE NOR AM I REGISTERED TO VOTE WITH ANOTHER TRIBE* Signature Date Please complete one for ALL minors. Under 16 years of age parent will need to sign* 16 years and older need to sign for themselves. Once you reach the age of 18 years you can vote. Under 16 years of age parent will need to sign* 16 years and older need to sign for themselves. Once you reach the age of 18 years you can vote. IF YOU LIVE OUTSIDE OF THE CHOCTAW NATION OF OKLAHOMA YOU MAY AFFILIATE WITH ONE OF THE DISTRICTS BELOW* ONCE YOU AFFILIATE YOU MUST REMAIN IN THE DISTRICT YOU HAVE CHOSEN* Residents Residents of the Choctaw Nation ten and one-half counties will be registered in the precinct in the county in which they reside. IF YOU LIVE OUTSIDE OF THE CHOCTAW NATION OF OKLAHOMA YOU MAY AFFILIATE WITH ONE OF THE DISTRICTS BELOW* ONCE YOU AFFILIATE YOU MUST REMAIN IN THE DISTRICT YOU HAVE CHOSEN* Residents Residents of the Choctaw Nation ten and one-half counties will be registered in the precinct in the county in which they reside. Absentee voting will be allowed by written request to the Election Board Chairman prior to an election or referendum* Non-Residents Applicants residing outside the Choctaw Nation will be registered to vote by mail* Do you want your name and address released to the general public Yes No PLEASE CHECK THE PROPER DISTRICT AND PRECINCT.

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