2009 Ittawamba Spring Ordeals

Registration Form
Ceremony Team & Elangomats

USE THIS REGISTRATION FORM

ONLY if you are registering as a
ceremony team member or Elangomat
and will serve both ordeal weekends.

Date: ________________
Circle one: Youth Adult

Name : ______________________________

Street Address:_________________________

City: ______________________ State: ____

ZIP: _______ email: ____________________

Phone: _____________________
Circle one: Ordeal Brotherhood Vigil
Troop # or Unit: ______________
Which Dates ?:
__ March 27-28-29 or __ April 3-4-5
Amount Enclosed: $ _______ . 00
Gold Card #: __________________
Fax w/credit card information (731-668-3788)
 MasterCard  Visa  Discover
Card No. _____
Amt. charged $ ____ __ Exp Date ___
Signature ___ ____
MAIL THIS REGISTRATION FORM &
MONEY TO :
West TN Area Council, BSA
1995 Hollywood Drive
Jackson, TN 38305
Until March 20: $15.00 + $5.00 = $20
After March 20: $20.00 + $5.00 = $25