January 17, 2009
Kittatinny Lodge Banquet
Hawk Mountain Scout Reservation
Willits Dining Hall
6:00-9:00 PM
Cost: $10.00/person
(lodge members and family of lodge members Invited)
* * * Deadline to register is January 10, 2009 * * *
*** Please Print Clearly - Check if your dues are paid before registering ***
Name: __________________________________________________________________________
Lodge Member ID#: _____ _____ _____ _____
Phone: ( ______ ) ______ - ______________
Address: _________________________________________________________________________
City: ________________________________ State: __________ Zip: ____________________
Email Address: ____________________________________________________________________
FEES:
# Attending: __________ @ $10.00 TOTAL FEE ENCLOSED $_______________
Additional persons attending:
NAME Member (Y/N) Lodge Member ID
1) ___________________________________________________________________ _______ ______________
2) ___________________________________________________________________ _______ ______________
3) ___________________________________________________________________ _______ ______________
4) ___________________________________________________________________ _______ ______________
5) ___________________________________________________________________ _______ ______________
6) ___________________________________________________________________ _______ ______________
Mail completed form and fee to:
Last Update: 12/11/2008