5 District Voter Registration Form C N E C 123010

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NEW Cherokee Nation Voter Registration form for the June 25, 2011 Cherokee Nation Election. This form has new precincts and has the five district configuration effective as of the 2011 Inauguration. Voter Registration closes March 31, 2011 for the upcoming elections. Don\'t wait! Register and update your addresses, today!

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5 District Voter Registration Form C N E C 123010

  1. 1. Cherokee Nation Voter Registration Form Return to: Cherokee Nation Election Services Post Office Box 1188 Tahlequah, OK 74465-1188 (918) 458-5899 * 1-800-353-2895 * e-mail: election-commission@cherokee.orgNew Application Change of Affiliation (District or Precinct) Change of Name or Address Re-Active OtherOther:  You must have Tribal Citizenship (Blue Card)Name(Please print) First Middle Last MaidenMailingAddress Street, Box, Route Number, Road City State ZipHome AddressIf differentfrom mailing Street, Box, Route Number, Road City State Zipaddress Male FemaleCounty of Residency Date of Sex Phone No. Social Security No. (Optional) BirthBlue Citizenship Card No. Date Issued Your name as it appears on the Blue CardYour Signature DateWitnesses, if Mark used 1. 2. RESIDENT VOTERS MUST MARK ONE PRECINCT, NON-RESIDENT VOTERS SEE BELOW *District No. 1 District No. 2 District No. 3(Cherokee & Wagoner County) (Adair/ Delaware/ Ottawa County) (Sequoyah/McIntosh/Muskogee County)Precincts: Precincts: Precincts:A.  Tahlequah A.  Stilwell A.  VianB.  Keys B.  Westville B.  Marble CityC.  Hulbert C.  Cave Springs C.  SallisawD.  Briggs D.  Bell D.  MuldrowE.  Lowrey E.  Grove E.  BelfonteF.  Okay F.  Jay F.  Warner G.  Kenwood G.  Ft. Gibson H.  Kansas H.  Muskogee I.  Chewey J.  AftonDistrict No. 4 District No. 5(Craig/Nowata/Mayes/Washington County) (Tulsa/Rogers County) * New applicants age 25 or older who residePrecincts: Precincts: outside the boundaries must register to voteA.  Bartlesville A.  Tulsa at-large.B.  Vinita B.  CollinsvilleC.  S. Coffeyville C.  Claremore * New applicants under the age of 25 who resideD.  Nowata D.  Chelsea outside the boundaries may select to registerE.  Welch E.  Oologah at-large or in a district of your choice.F.  PryorG.  SalinaH.  Locust GroveI.  Spavinaw ATTENTION NON-RESIDENT VOTERS (CITIZENS NOT LIVING WITHIN THE TRADITIONAL BOUNDARY OF THE CHEROKEE NATION) CHECK HERE  FOR AT-LARGE VOTINGForm will be returned if it is not filled out properly. Call 1-800-353-2895 if there is a question.OFFICE USE ONLY

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