Tahltan Nation Member Information Form

The Tahltan Member List is a database of all people of Tahltan descent. It’s important all Tahltans are on the list and we have your current contact information to ensure you stay informed of news about our Nation, such as events, employment, scholarships and training opportunities, governance, administration and elections, projects in our territory, and potential impact benefit agreements (IBA). You’ll also be added to our Tahltan Members Voter List when our Nation is facing a vote.

Please answer the information below about you and members of your family. We will also need to know if you and your family members are of Tahltan ancestry (Answer: Yes/No/Not sure).

Full legal name (First, middle and last)*

First Name

Middle Name

Last Name

Birth name (First, middle and last)*

First Name

Middle Name

Last Name

Nickname

Date of birth*

Are you of Tahltan ancestry?*

Yes No I am not sure

Are you status or non status?

Status Non status

Status card number

Birth mother's maiden name: (full legal)*

First Name

Middle Name

Last Name

Married name*

Is she Tahltan or not?

Yes No I am not sure

Birth father's name: (full legal)*

First Name

Middle Name

Last Name

Is he Tahltan or not?

Yes No I am not sure

Married name*

Mother's mother's full maiden name: (full legal)*

First Name

Middle Name

Last Name

Is she Tahltan or not?

Yes No I am not sure

Mother's father's full name: (full legal)*

First Name

Middle Name

Last Name

Is he Tahltan or not?

Yes No I am not sure

Father's mother's full name: (full legal)*

First Name

Middle Name

Last Name

Is she Tahltan or not?

Yes No I am not sure

Father's father's full name: (full legal)*

First Name

Middle Name

Last Name

Is he Tahltan or not?

Yes No I am not sure

Tahltan family name:(e.g. Goodzama)

Name of spouse: (full, legal)

First Name

Middle Name (optional)

Last Name

Is he/she Tahltan?

Yes No

Children: if you have children, please list their names and birthdates below e.g John Smith, 1990-09-01, Status card no:123456, other parent's name: Lee Smith, and Lee is Tahltan.

Mailling address:(Include street number and name, post box and rural route number)*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Home number

Mobile number

Work number

Email

How would you like to receive information from the Tahltan Central Government? *

Email Canada Post Phone Text I don't want to receive information

Other:

Please select all that applies to you

It is important all members of the Tahltan Nation are included in this member list so they can receive information and talk to us. Please provide us with contact information for other members of your family or friends that we should be in contact with: e.g: John Smith, 250-221-2222, johnsmith@gmail.com