The Klamath Tribes
Member Benefits Department
501 Chiloquin Boulevard
PO BOX 436
Chiloquin, OR 97624
Phone: (541) 783-2219 | Fax: (541) 783-7768
Enrollment Ordinance §4.04, Confidentiality
Enrollment documents are confidential unless release is authorized by the applicant or his/her legal guardian.
Please add Suffix (Sr., Jr., III) after last name.
If this application is being submitted on behalf of a minor or adult under guardianship,
provide thefollowing information for the person submitting this application:
The enrollment record information will be release by:
The Klamath Tribes Member Benefits Department 501 Chiloquin Boulevard, PO BOX 436, Chiloquin, OR 97624
The enrollment record information will be released to:
herby voluntarily authorize the release of the above listed information from my enrollment record. I understand this will be a one-time release for the document(s) listed above.
*Must ensure legal documentation showing guardianship is on file.
This document was prepared under the provision of the Enrollment Ordinance Klamath Tribal Code Title 1 Chapter 4, approved February 23, 2008 by General Council, Revised September 26, 2013.