Unit Registration Form

(Please use a separate form for each clinic)

__________

Unit   Number

Charter   Organization:

_____________________________________

_______________________________

Unit   Contact:

Telephone:

________________________

List the name of each Scout attending the clinic and the merit badge he will take:

Scout's Name

Merit Badge

Scout's Name

Merit Badge

__________________________     ________________     __________________________     ________________

__________________________     ________________     __________________________     ________________

__________________________     ________________     __________________________     ________________

__________________________     ________________     __________________________     ________________

__________________________     ________________     __________________________     ________________

Registration fees (you only need to complete one line, based on when you register):

Count

Fee

Subtotal

__________

Number   of Scouts registered by mail by the   1st

$2

__________

__________

__________

Number   of Scouts registered at Roundtable

$3

__________

__________

Number   of walk-in Scouts

$5

__________

(Note: No walk-ins for Woodworking   or Electricity)

__________

Number   of Scouts registered for Woodworking   or Electricity

$5

__________

Account Number (please write on check):1.6801.291.20

TOTAL FEE

Special Rules for Woodworking and Electricity:

Due to the nature of these clinics, any Scout who wants to attend these clinics must pre-register.  The cost for each clinic is $5.  One adult must accompany every two Scouts.  Each class is limited to 20 Scouts