2022 Goldbelt Board of Directors Disclosures

REQUIRED DISCLOSURES, AGREEMENTS, AND RESPONSIBILITIES TO BE INCLUDED IN THE PROXY MATERIALS
Name(Required)
First Middle Last Suffix
Alaska Native or Tlingit Name
Age(Required)
Residence Address(Required)
"Residence" means residence for purpose of voting, as determined under Alaska Statute 15.05.02

City State / Province / Region

EMPLOYMENT OR OCCUPATION IN THE LAST FIVE YEARS
Title or Occupation(Required)
If you are considered retired, self-employed, or unemployed please indicate in your title
Current Employer(Required)
Start Date(Required)
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY

Employment History

Employer or Occupation	Title	Actions

There are no Entries.

Have you ever held, or do you currently hold any contracts, positions, or offices at Goldbelt or Goldbelt-funded organizations, including any affiliiates, subsidiaries, limited liability corporations, non-profit organizations, or trusts?(Required)
- Yes
- No
List all positions(Required)
Between January 2017 and present, have you served as a director for any non-Goldbelt entities or companies?(Required)
- Yes
- No
List all positions(Required)

Continuing Director Submission Responsibility(Required)
Checking the box below indicates that you have read and understand the information being provided.
- I understand that I must submit a recent photo (taken within the last five years) to elections@goldbelt.com for inclusion in the corporate proxy.
Goldbelt is required to include my name on its proxy, my biographical information, disclosures, photograph, and management-provided board and committee meeting attendance, I hereby agree to the following
Checking each box indicates that you have read and understand the information being provided.
- I have read and agree to comply with Goldbelt’s Bylaws and Goldbelt’s Election Rules.
- I agree that any decision made by majority vote of the Goldbelt Board of Directors is final.
Electronic Signature(Required)
By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this packet.
Email(Required)
To receive a confirmation of your submission along with a copy of your responses, provide a valid email address below.

Goldbelt Board of Directors Disclosures