150th Anniversary – Battle of Perryville

2012 – Boy Scout Registration Form

 

Troop Name:     ____________________________________________________________________

Troop Leader:    ____________________________________________________________________

Mailing Address: __________________________________________________________________

City, State, Zip:  ____________________________________________________________________

Email Address:  ____________________________________________________________________

Total Participants    x fee per person =  $      

Registration Fees are $5.00 per scout with a limit of 1 chaperon per every 4 scouts registered.

Please Make Checks Payable to: Kentucky State Treasurer

Registration deadline for all scout participants is September 1, 2012. Due to the size of the event late registrations and walk-on registration will not be permitted.

Print and Mail to: Perryville Battlefield Scout Registration PO Box 296 1825 Battlefield Rd. Perryville, KY 40468

List All Participants by Name - Please Print Legibly
 

1. _____________________________________________

2. _____________________________________________

3.______________________________________________

4. _____________________________________________

5. _____________________________________________

6. _____________________________________________

7. ____________________________________________

Use additional sheets if necessary

8. _____________________________________________

9. _____________________________________________

10. ____________________________________________

11. ____________________________________________

12. ____________________________________________

13. ____________________________________________

14. _____________________________________________

By submitting this registration form, we unconditionally agree to abide by the standards set in the rules booklet.

__________________________/_________
 Signature of Authorized Unit Representative and Date

 Office Use only:     Date Received: ___/___/___

 By: ________ Acknowledgment Sent ___/___/___