GILA LODGE - ORDER of the ARROW Spring Ordeal Member Registration Form Cochise - Geronimo - Mescalero - Nesatin - Tortugas - Wapaha  Yucca Council, Inc., Boy Scouts of America  P.O. Box 971056, El Paso, Texas 79997-1056 7601  Lockheed Drive, El Paso, Texas 79925  Telephone 915-772-2292, Fax 915-772-4535

EVENT:    2006 Gila Lodge Spring Fellowship – May 5 - 7, 2006 
TIME:       Member registration; Friday, 7:00 to 8:00 P.M. Depart; Sunday 10:00 A.M. 
WHERE:  Camp Dale Resler, Cloudcroft, NM 

ALL LODGE MEMBERS WHOSE ANNUAL DUES ARE PAID 
_____ I will attend the Spring Fellowship and have enclosed the registration fee of $13.00. I understand that this fee must be at the
              Yucca Council Office not later than April 28, 2006. 
_____ I will attend the fellowship and will pay the late registration fee of $18.00 at Camp. ALL LODGE MEMBERS WHOSE 

ANNUAL DUES ARE NOT PAID (SEE YOUR MAILING LABEL) 
_____ I will attend the Fall Fellowship and have not paid my 2006 lodge dues (01-01-2006 to 12-31-2006) enclosed is the $13.00 plus
             an additional $10.00 for dues, a total of $23.00. I understand this fee must be at the Council office not later than April 28,
             2006. 
_____ I cannot attend the Spring Fellowship but wish to pay my 2006 lodge dues (01-01-2006 to 12-31-2006) to remain active,
             enclosed is $10.00 

Name __________________________________ Address ______________________________________
City ______________________________ State ______ Zip ________ Telephone ___________________
Date of Birth _____________________Unit # ____________________ District ______________________
Rank (youth) __________________________ or Position (adult) __________________________________
Signature _________________________________________________________ Date ________________
Total Enclosed: $_________ Cash _____ Check _____ Please make checks payable to: “Gila Lodge - B.S.A.”
Credit Card:  #________________________________________________________expires:____________

All participants under the age of 18 (DOB after 5/05/88) must complete the Medical & Permission Form below. Other
participants should complete to ensure their medical history is available if needed.

Parent’s Name ________________________ Address ________________________________
City _______________ State ______ Zip ________ Telephone (home #) _________________
Telephone (work #) ___________________________ (emergency #) ____________________
Family Physician _________________________________ Telephone ___________________
Health Insurance _______________________________________ Policy No. _____________
Date of immunization for tetanus toxoid ____________________________________________
Any condition that may require special care? _______________________________________
Any condition now requiring regular medication? ____________________________________
Any special dietary requirements? ________________________________________________
Any restriction of activity for medical reasons? ______________________________________

PARENT OR LEGAL GUARDIAN AUTHORIZATION

This health history is correct so far as I know, and the person herein described has my permission to attend the event described above and to engage in all prescribed activities, except as noted by me. In the event I cannot be reached in an emergency, I hereby give my permission to the physician, selected by any adult leader in charge, to hospitalize, secure medical care and proper anesthesia, or to order injection for my son.  

PARENT SIGNATURE _______________________________________ DATE____________

The weekend ceremonies are solemn and reverent. In order to keep interruptions to a minimum, we are asking that anyone that must leave before Sunday morning call George Foret (915-820-9240) before Friday, April 28, 2006 to make arrangements to open the gate at 9:00 pm on Saturday night when the ceremonies and meetings are concluded. The gate will not be opened before 9:00 pm.