Langundowi Lodge #46 Form printable pdf download

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Langundowi Lodge #46

Dues for 2016-2017

Please verify the following information is correct, make any changes, and send

before April 30, 2016

this entire form with payment

Please follow these simple instructions and your new membership card will be mailed to you soon.

Name: _________________________________

Complete the information. Please pay particular attention to the mailing address and your contact

Address: _______________________________

information, as this is how we will contact you during the upcoming year. Update your Scouting

information (ie position, rank, etc).

City, State, Zip: __________________________

Indicate you would like to purchase a lodge flap by writing the $5.00 fee in the space provided.

Send (or bring) this entire form and payment to the McGarvey Scout Service Center. Your BSA

membership will be verified (another reason to check you Scouting information) and your dues form

Ordeal, Brotherhood, Vigil: __________

processed by the lodge. (Partial forms will result in delays.)

You membership card and flap (if purchased) will be mailed to you.

Date of Birth: ________________

In an effort to improve our communication with our members, we maintain the following information.

Please complete the following information if applicable:

You must be a registered member of the BSA BEFORE

you can be an active member of the Order of the Arrow.

Cell Phone Number:

_____________

Texting NOT Permitted

Your District of registration is ____________

Home Telephone:

_____________

Fax Phone Number:

_____________

You are a member of unit: ______________

Work Phone Number:

_____________

In the position of _____________________

e-mail:

__________________________

Have attained the rank of ______________

In the event of an emergency at a lodge activity, please provide a emergency contact information:

Name:

____________________________ Relationship: _____________________ Phone Number: ______________________

Name:

____________________________ Relationship: _____________________ Phone Number: ______________________

Enclosed, Payable to French Creek Council, BSA

You may purchase One Langundowi lodge flap when

2016-2017 Dues .......................................................................... $15.00

you pay your dues, Additional lodge flaps can be

Lodge Flap @ $5.00 ................................................................... ___.___

purchased at each lodge event, except Ordeals.

Centennial Project Contribution ................................................... ___.___

Total Enclosed 900048 .............................................................. ____.___

Langundowi Lodge #46 Form

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