Wood Badge for the 21st Century

:ood Badge Participants Learn To:
™ View scouting globally as a Iamily oI inter-related value-based
programs that provide age appropriate activities Ior youth.
™ Recognize the contemporary leadership concepts utilized in corporate
America and leading government organizations that are relevant to our
value-based movement.
™ Apply the skills learned Irom participation as a member oI a successIul
working team.
™ Revitalize commitment by sharing in an overall inspirational
experience that helps provide Scouting with the leadership it needs to
accomplish its mission on an ongoing basis.

Name: Date oI Birth: M F

Address: Home Phone:

City: State: Zip Code:

E-Mail Address: Business Phone:

Occupation: Employer:

Council: District:

Unit No: Years in Scouting as Youth: as Adult:

Present Scouting Position: Cub Scout %R\Scout
Varsity Venturing
Tenure in Current Position:

I completed the training requirements Ior my current position on:

Check a box below Ior the course you would like to attend.

2010 Course 'ates
Weekend ** Mar 12-14 & 26-28 Heard Pueblo Karl Brandenberger (602) 237-4880
Weekend * Apr 22-24 & May 6-8 Yuma Craig Colvin (928) 317-8282
Weeklong June 7-12 FlagstaII Robert Reeves (480) 275-8044
Weekend * Aug 26-28 & Sep 9-11 R-C Tom Vanderwalker (480) 850-5761
Weekend * Oct 14-16 & Oct 28-30 R-C Mallene Elicio (928) 651-5596

*7hu Sat (Two Weekenas. vou must attena both weekenas to complete the course)
**Fri Sun (Two Weekenas. vou must attena both weekenas to complete the course)
Please note. A complete Annual Health ana Meaical Recora form must be completea prior to attenaing a course.

Please reserve my place Ior the course I have checked. I am including a $ ($50 minimum deposit) check to
reserve my place in the selected course. I understand the balance oI the $215 course Iee must be paid 30 days
prior to the start oI the course. I understand that iI my balance is not Iully paid by 30 days prior to the start oI my
selected course, my place in that course is IorIeited to others wishing to attend. If I am unaEOe to attend my
regLstered Fourse and Lf I notLfy the CounFLO 6erYLFe Center at Oeast 30 days SrLor to the start of the Fourse I
wLOO Ee entLtOed to a fuOO refund of aOO fees SaLd. $OO refund requests must Ee reFeLYed Ln wrLtLng. HoweYer Lf
notLfLFatLon Ls gLYen to the CounFLO Oess than 30 days SrLor to the start of the Fourse aOO fees wLOO Ee refunded
exFeSt for $50 of my LnLtLaO deSosLt whLFh shaOO Ee forfeLted.

Please make checks payable to: Grand Canyon Council, and return this application with payment to:
Grand Canyon Council, 2969 N. GreenIield Rd., Phoenix, AZ 85016-7715.

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