Contact Information Update Form

The Klamath Tribes
Member Benefits Department

501 Chiloquin Boulevard
PO BOX 436
Chiloquin, OR 97624
Phone: (541) 783-2219 | Fax: (541) 783-7768

It is the responsibility of each enrolled Klamath Tribal Member to ensure the Member Benefits Department has current contact information.

Applicant’s Information:

Please add Suffix (Sr.,Jr., III) after last Name.

New Address Information

Type N/A if Not Applicable

13. Minors affected by this change include:

14. If this application is being submitted on behalf of a minor or adult under guardianship, provide thefollowing information for the person submitting this application:

15. By signing this document, I certify that the information provided is accurate and true to the best of my knowledge.

*Must ensure legal documentation showing guardianship is on file.
Click or drag a file to this area to upload.