Brotherhood Candidate Registration Form 
Return to: Gila Lodge, PO Box 971056, El Paso, TX. 79997 

EVENT: 2006 Gila Lodge # 378 Spring Ordeal 
DATES: Friday, May 5, 2006 through Sunday May 7, 2006 
TIME: Member registration: Friday 7:00 to 8:00 PM Depart: Sunday 10:00 AM 
WHERE: Camp Dale Resler, Cloudcroft, NM. 

ALL LODGE MEMBERS WHOSE ANNUAL DUES ARE NOT PAID (SEE YOUR MAILING LABEL) 
_______ I will attend the Fall Fellowship, am a Brotherhood Candidate and have not paid my 2006 Lodge Dues (01-01-2006 to
                 12-31-2006) enclosed is the $13.00 registration, $10.00 for dues and $12.00 to pre-pay my Brotherhood Sash (will be available
                at the Brotherhood walk on Saturday), a total of $35.00. (You must be current on your dues to participate in the Fellowship
                Activities). I understand that this fee must be in the council office no later than April 28, 2006. 
_______ I cannot attend the Fall Fellowship and will seal my membership at a later date, but wish to pay my 2006 Lodge dues
                (01-01-2006 to 12-31-2006) to remain active, enclosed is $10.00. 

ALL LODGE MEMBERS WHOSE ANNUAL DUES ARE PAID
 ______ I will attend the Fall Fellowship, am a Brotherhood Candidate, enclosed is the $13.00 registration and $12.00 to pre-pay my
                Brotherhood Sash (will be available at the Brotherhood walk on Saturday), a total of $25.00. I understand that this fee must
                be in the council office no later than April 28, 2006. 
______ I will attend the Fall Fellowship am a Brotherhood Candidate and will pay the late registration fee of $18.00 and $12.00 for my
               Brotherhood Sash a total of $30.00 at Camp. 

Name __________________________________ Address _________________________________________
City __________________ State ______ Zip ________ Telephone ___________________________________
Unit _______ Division/District___________ Rank (youth) ___________ Position (adult) ___________________
Date of Birth _______________ E-mail address: __________________________________________________
Total Enclosed: $ _______ Cash ____ Check _______ Please make check payable to: “Gila Lodge – BSA” 
Credit Card MC/VI/DS ____________________________________________ exp _____________________

Candidate Acknowledgment: I agree to conduct myself as a Scout at all times and to comply with all rules and policies of the Boy Scouts of America, the Yucca Council, the Gila Lodge, and Camp Dale Resler. 
Candidate Signature: _______________________________________________Date: __________________

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

Parent’s / Spouse’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. 

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.