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ALLOHAK COUNCIL
B O Y SCOUTS OF A M E R I C A
MERIT BADGE COUNSELOR APPLICATION
UNIT #______________ DISTRICT____________________________________
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NAME:____________________________________________________ BIRTH DATE:_____________________ ADDRESS:___________________________________________________________________________________ CITY/STATE/ZIP:_____________________________________________________________________________ O C C U PATION:________________________________________________________________________________ E-MAIL:____________________________________________________________

SOCIAL SECURITY NUMBER:_____________________________________________________________
PHONE: (Home)________________________________ (Work)_________________________________________
I wish to work with only _________
I wish to work with all units________
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must be r egister ed
you must complete a BSA Adult Application
This must be done yearly
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