Question Title

* 1. Please enter your full legal name

Question Title

* 2. Please enter your address
Your check will be mailed to the address you enter below

Question Title

* 3. Please enter your email address and phone number below

Question Title

* 4. Please enter your enrollment number

Question Title

* 5. Please upload a copy of your Lummi Nation Tribal ID
Your check will not be mailed if your Tribal ID is not uploaded

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 6. Please upload a picture of you holding your Lummi Nation Tribal ID
Your check will not be mailed if you do not upload a picture of you holding your Tribal ID

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 7. Please enter your date of birth

Date

Question Title

* 8. By typing your full legal name below you certify that you are the parent or legal guardian, of the Lummi enrolled minor stated above. I understand LIBC will not be liable for lost, stolen, or misused gift cards. I further certify that I as the custodial parent/guardian assume full responsibility for the gift card and agree to use the card for the sole intended purpose of basic needs for the minor stated above. In the event of a dispute, gift cards will be withheld until a certified court order identifying custodial rights is received. Any gift cards unlawfully claimed will be voided immediately and subject to prosecution.

T