Adventurer Club Registration

Director's Name *

First

Last

Year of Registration *

The year you are registering for...

Name of Club *

Name of Club

Name of Church *

Name of Church

Area *

Director's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Address

Is the Director a Master Guide? *

Yes
No

Is the Director a Master Guide?

Director's Email *

Email

Confirm Email

Director's Email

Director's Phone *

Director's Phone #

Membership:

# of Men *

Total # of Men in the club

# of Women *

Total # of Women in the club

# of Boys *

Total # of Boys in the club

# of Girls *

Total # of girls in the club

Staff Names

The following individuals are presently serving as officers and staff members of the above-named adventurer ministry and desire to be registered with the northeastern conference adventurer federation for the current year.

Staff #1 Name *

First

Last

Staff #1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Staff #1 Phone

Staff #1 Email *

Email

Confirm Email

Staff #1 MasterGuide?

Yes
No

Staff #2 Name *

First

Last

Staff #2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Staff #2 Phone

Staff #2 Email *

Staff #2 Master Guide?

Yes
No

List of Staff *

Place First and Last Names here. Each on a separate line. ( If none, type n/a)

Membership:

Staff Names

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