Sequoia Council Wood Badge Application Form (Page 3 of 3) in pdf

Sequoia Council Wood Badge Application Form Page 3

Sequoia Council Wood Badge 2013

Weekend #1 Friday September 6 to Sunday September 8,

Weekend #2 Friday September 20 to Sunday September 22, 2013

The course fee is $250. A $50 deposit is due at the time the application is submitted.

Name________________________________________________________________

Address_____________________________________________________________

City________________________________________________ ZIP_____________

Day Phone _______________________ Evening Phone _______________________

Email ________________________________________________________________

Council _______________________________ District ____________________________

BSA Member ID# _____________________ Circle one: Pack, Troop, Team, Crew, Ship #_____

Current Registered Position ______________________________________________________

Occupation ___________________________ Employer ________________________________

Gender _____________________________ Birth Date (mm/dd/yyyy) _____________________

____payment enclosed (checks payable to Sequoia Council BSA)

____please charge my ____VISA ____MasterCard ____Discover

Account # _____________________________exp date. __________Sec. Code_____

Signature_________________________________________________________

Mail completed form with payment to:

Fresno Service Center 6005 N. Tamera Ave. Fresno, CA 93711-3911

Visalia Service Center 230 NW 3rd Ave. Visalia, CA 93291-3628

For more information contact:

Boy Scouts of America, Fresno Service Center 559-320-2100

Boy Scouts of America, Visalia Service Center 559-732-3424

Kim Borgardt, 2013 Course Director,

559-779-3641

Sequoia Council Wood Badge Application Form Page 3