Scout’s NAME: ____________________________ / ________________________________ / ___________________________ Parent’s NAME: ____________________________ / ________________________________ Address ___________________________________ City ____________________ State _______________ Zip Code ___________ Home Phone: (_____) _____ - _______ Email Address:_________________________________________ Number of Webelos: ___________ x $_____________ = _______________ Number of Webelos Parents: ___________ x $_____________ = _______________ Number of Webelos: ___________ x $_____________ = _______________ Number of Webelos Parents: ___________ x $_____________ = _______________ Number of Scouts: ___________ x $_____________ = _______________ Number of Ventures: ___________ x $_____________ = _______________ Number of Adults: ___________ x $_____________ = _______________ Total: _______________ Register Online and receive a $2.00 per person Discount Location: Florida Elks Youth Camp 24175 SE Highway 450, Umatilla, Florida 32784 Contact: John Larsen 407-489-4186 / [email protected]or Brian Nead 407-765-9469 / [email protected]Code F-501 First Last 20.0 Please Print Clearly: CASH CHECK VISA MC DISCOVER AM. EX. (Circle One) Card #:I I I I I I I Exp. Date _____ / _____ Card Holders Phone #: (_____) ______-________ 3/4 Digit Security Code Signature: Total Amt; ___________________ Check #: _____________________ Payment Instructions: Make Checks Payable to: Mail or Drop off: Fax In: (407) 899-4406 “CFC BSA” Wayne Densch Scout Service Center 1951 S. Orange Blossom Trail All Registrations must be received by September 27, 2015. First Last For Double Feature Discount* * Webelos and Parents who register for the district Cub Family Weekend are eligible for the Double 14.0 20.0 20.0 20.0 20.0 For Double Feature Discount* District Program Chair Unit # District Camping Chair
All Registrations must be received by September 27,
2015.20.0020.0020.00 10.0020.0020.00FirstLastUnit
#LastFirstDistrict Camping ChairDistrict Program ChairScouts NAME:
____________________________ / ________________________________ /
___________________________Parents NAME:
____________________________ / ________________________________
Address ___________________________________ City
____________________ State _______________ Zip Code ___________Home
Phone: (_____) _____ - _______ Email
Address:_________________________________________Number of Webelos:
___________ x $_____________ = _______________Number of Webelos
Parents: ___________ x $_____________ = _______________Number of
Webelos:___________ x $_____________ = _______________Number of
Webelos Parents:___________ x $_____________ =
_______________Number of Scouts: ___________ x $_____________ =
_______________Number of Ventures: ___________ x $_____________ =
_______________Number of Adults: ___________ x $_____________ =
_______________Total: _______________Register Online and receive a
$2.00 per person DiscountLocation: Florida Elks Youth Camp 24175 SE
Highway 450, Umatilla, Florida 32784Contact: John Larsen
407-489-4186 / [email protected] or Brian Nead 407-765-9469 /
[email protected] Code F-501Please Print Clearly:CASH CHECK
VISAMC DISCOVER AM. EX.(Circle One)Card #:I I I I I I I I I I I I I
I I I I Exp. Date _____ / _____ Card Holders Phone #: (_____)
______-________3/4 Digit Security CodeSignature:Total Amt;
___________________Check #: _____________________Payment
Instructions:Make Checks Payable to:Mail or Drop off:Fax In: (407)
899-4406CFC BSAWayne Densch Scout Service Center1951 S. Orange
Blossom TrailSuite 102Apopka, FL 32703For Double Feature Discount**
Webelos and Parents who register for the district Cub Family
Weekend are eligible for the Double Feature Discount.14.00For
Double Feature Discount*
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