Name (Please Print)	Youth/Adult	Extra Patch (included with Youth Fee)
			1
			2
			3
			4
			5
			6
			7
			8
			9
			10
			11
			12
			13
			14
			15
			16
			17
			18
			19
			20

 

Troop/Pack #___________              Nights Camping (please circle)

                                                                                    Friday               Saturday

# of Youth Attending (@ $7)______ = $_______

#of Adult Patches (@ $2)     ______  = $_______

Total Amount Inclosed $_______

 

Preregistration Due By February 3, 2002

Cost at the Door is $9

Mail to:

Golden Eagle Klondike Derby

Mid-Iowa Council

P.O. Box 3009

Des Moines, Iowa 50316

 

All Fees are Transferable to Another Person in the Same Unit, but are Non-Refundable