NICOA Member Online Application

Instructions

Thank you for supporting National Indian Council Aging Inc. Instructions are below.

1. Name – please provide your name.

2. Personal Mailing Address - NICOA would like to be able to reach our community to inform you of upcoming events that you may be interested in. No junk mail, etc. We will NEVER sell your information or share it with anyone without your permission.

3. Email Address – We would like to keep you updated about what is happening and add you to our Newsletter list with valuable information about what is happening in Indian Country. We will never sell or share your information without your written permission.

4. Billing or Tribal Contact- Contact information of the person, tribe, or organization that is paying the membership dues for the person listed above. If you are paying leave this section blank. We ask for this information if there is a billing question.

5. Voting Member Only – This section needs to be filled out for a Voting Member; this is a person that is 55+ years of age, they are a member of a federally recognized Tribe. Please attach a copy of your Certificate Degree of Indian Blood (CDIB) or Tribal enrollment letter.

6. Membership Type- Check the box next to the type of member you are.

• Voting Member- Must be 55 years or older and a registered member of a federally recognized American Indian or Alaska Native tribal entity. A Voting Member can attend their regional caucus session at the conference, vote on resolutions, and elect their regional representative on the NICOA Board of Directors. Additionally, Voting Members play a role in shaping NICOA’s direction for the next two years and receive a reduced conference registration fee. Voting on the regional representative occurs every four years, spanning two conferences.

• Associate Member (non-voting)- Any person who does not qualify to be a Voting Member.

Please fill out one form per person. Once the form is completed, please send the following to NICOA.

• Membership Dues Form

• CDIB or Tribal Enrollment Letter

• Payment

National Indian Council on Aging

Attn: Billie Tohee (Membership Dues)/Accounting

8500 Menaul Blvd. NE, Ste. B470

Albuquerque, NM 87112

If you have any questions, please contact the NICOA office at (505) 292-2001 or email [email protected].

Select An Option

Associate Member

any person not eligible to be a voting member

Voting member

A qualified voting member is “any Indian 55 years of age or older who is an enrolled member of an Indian Tribe, Band, or Combination of Bands and Tribes, recognized by the United States Department of the Interior”. PLEASE ATTACH A COPY OF PROOF OF TRIBAL ENROLLMENT OR CIB CARD. IF YOUR CIB CARD IS NOT AVAILABLE-YOU MUST HAVE YOUR TRIBE’S AUTHORIZED ENROLLMENT OFFICIAL ATTEST TO THE FOLLOWING.

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameTribe Name

Please select a valid membership option and fee item if exist