The year you are registering for...
Name of Club
Name of Church
Home Address
Is the Director a Master Guide?
Director's Email
Director's Phone #

Membership:

Total # of Men in the club
Total # of Women in the club
Total # of Boys in the club
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.
Place First and Last Names here. Each on a separate line. ( If none, type n/a)