Name ____________________________________     Telephone # __________________________
Address __________________________________________
City ______________________ State ______ Zip ________ 
Date Of Birth: ________________________ 
E-mail address: ___________________________________________

Rank (youth) __________________________ or Position (adult) _______________________________________________ 
Youth or Adult _________ Male or Female __________ 

Signature: _____________________________________________ 
 
Total Enclosed: $ _________________ Cash ____ Check _______ Please make check payable to: 

Gila Lodge, Order of the Arrow

A deposit of $100 is REQUIRED no later than November 1, 2005. 

The overall cost to attend is estimated at $850. If you have questions contact Jim Karol at 915-585-2437 or 
Jim Karol@aol.com. Please send reservation deposit to: Order of the Arrow, P.O. Box 971056, El Paso, TX, 79925 

PARENT OR LEGAL GUARDIAN AUTHORIZATION 

All participants under the age of 18 (DOB after 07/29/87) must have Parental Permission. 

I approve my son’s attendance at NOAC 2006: 

Parent’s Name _____________________________ 
Address_______________________________ 
City ______________________________ State ______ Zip ________ 
Phone (H) ____________________ Telephone (work #) _______________________ 

SIGNATURE ____________________________ DATE _________________

page updated 03/11/06_sAm