CHARTER RENEWAL
Council
Program
Unit
District Name/Number
Expire
Registration
No.
No.
Date
Team
OVERFLOW PAGE
Chartered organization _____________________________________________________
❑
❑
Youth roster
Adult roster
Use separate pages for youth and adult members.
Boys’
(Print First Name First)
Phone Number
Date of Birth
Grade
Sex
Position
Life
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
Name _________________________________________________
Address _______________________________________________
City ______________________ State ______ Zip ___________
524-421
2012 Printing