SCAVVIES INFORMATION

THIS MUST BE COMPLETED BY ALL SCAVVIES PRIOR TO THE INITIATION

DATE: ________________

FIRST NAME: ______________________ LAST NAME:_____________________

ADDRESS ___________________________________________________________

CITY STATE

PHONE: _____________________

AGE ____________ DATE OF BIRTH: _______/______/_________

DAV MEMBERSHIP NUMBER ________________________

DUGOUT GOING INTO ________________________________________________

$20.00 PART LIFE PLUS $______.00 REGISTRATION FEE

TOTAL $__________.00

AMOUNT PAID $___________

PERSON RECEIVED MONIES ______________________REGISTRATION DESK ONLY

I understand that one of my sponsors must walk me through the Third Degree. Failure to do so will make me ineligible for the Third Degree, and I will not be a member of the NOTR until such time.

_____________________________________ ________________

SCAVVIE SIGNATURE DATE

Remarks by the registration desk: