Member Information Update

Keeping your contact and personal information up to date helps us stay connected with you and ensures you don’t miss out on important news, programs, and services.

Please complete this form if your address, phone number, email, banking, or other personal details have recently changed. This information is kept confidential and used only for official Haisla Nation purposes.

If you have any questions or need help filling out this form, please contact the Membership Department at (250) 639-9361.

Member Information

Legal First Name

Legal Middle Name

Legal Last Name

Status Number (Last 4 Digits Only)

Your Address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Phone/Mobile Number

Banking Information

To ensure the accuracy of our account information, it is required that you attach a void cheque or direct deposit form from your bank and
complete the following financial information:

Name of Financial Institution

Last 4 digits of account number

Account Type

Savings

Chequing

Void Cheque\Deposit Form Upload

Choose File

I/We hereby consent to the release of the above information to the Finance Department (Your financial information will never be distributed outside of the Finance department.)

Signature

Sign Here

500 Gitksan Ave.

250-639-9361

communications@haisla.ca

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Member Information Update