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OA Troop/Team Representative |
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Registration Form for the OA Troop/Team Representative for Nischa Chuppecat 212 |
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| Today's Date________________________ |
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| Term of Office____________________________ |
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Beginning and ending date_______________________________________________ |
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| Name ______________________________ Troop/Team#________________________ |
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Address_____________________________ District_____________________________ |
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| Ordeal; Brotherhood; Vigil (Circle one) |
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| Lodge dues must be paid for term of office |
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| Phone____________________ FAX_________________ E-mail____________________ |
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| Scouting Experience_______________________________________________________ |
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| ________________________________________________________________________ |
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| ________________________________________________________________________ |
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| OA Experience___________________________________________________________ |
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| _______________________________________________________________________ |
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| _______________________________________________________________________ |
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| Please Return Completed Form To: |
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| Tony E. Barringer |
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11712 E. 100 S. |
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Columbus, IN 47203-9599 |
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| Unit Leader information: |
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| Name:_______________________ |
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| Phone:_______________________ |
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For any further information about this new program contact: |
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Vice Chief of administration |
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Byron Johnson |
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Tony E. Barringer |
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(812) 579-5540 |
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[email protected] |
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Doug or Sara Seaborne |
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[email protected] |
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(812) 526-2955 |
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