WESTERN CHEROKEE, A Missouri Non profit Corporation

Corproate Memebers' (all of which are Tribal Citizens) Request for information

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Please note the following in reference to this form:

This form is for the exclusive use of members of the corporation, whom, by virtue of definition pursuant to the by laws for same, MUST be Citizens of the Western Cherokee Nation. All others are requested to visit http://www.westerncherokeenation.org/ for contact information.

All items marked with an asterisk (_*) are required to be answered to properly handle your request.

Please utilize Information Tags ( ); mouse over to read instructions.

Full Name * Please enter your full name as shown on your enrollment/citizenship card
Enrollment Number * Enter your enrollment number in this area - this is a required entry
Primary E-Mail Address * Please enter your primary email address here.
Alternate e-mail address If you have a secondary or alternate e-mail address, please enter it here.
Mailing Address-Line 1 * Please enter the first line of your mailing address here
Mailing Address-Line 2 Please enter the second line of your mailing address here
City * Please enter you mailing address city in this area.
State * Mailing Address State to be entered here please.
Country * Please select your mailing address country here.
Postal Code * Please enter Postal Code in this area
Daytime Telephone Please Enter Daytime Telephone number here. (Optional)
Night Telephone Please enter your night telephone number here (Optional)
Voter Registration Status * Please select the most appropriate option - this field is required.Currently RegisteredDo not wish to be registeredUnsure of Registration StatusWould Like to be registered to vote
I request information on * Please enter your question(s) and what information that you are seeking in this area.
Priority of Request * Please assign a priority to your question(s) here.
Do you wish to be personally contacted? *NoYes, by telephoneYes, by e-mailYes, by US MailI desire an appointment to discuss matter at the Capitol Complex
Reply Requested From If there is a specific person that you wish to answer your question, please list that person here.
WCN Voice Subscription * Please indicate your preference for receiving or not receiving the WCN Voice e-mail list postings.Already SubscribedNoYes