Date Today: ___-___-___

Name: ______________________________________________________________  

Address: ___________________________________________________________

City, State, Zip: __________________________________________________

Phone: (Home)_____________  (Cell)_____________  (Work)_____________

Email: _____________________________________________________________
 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 

Unit: ______________ District: ______________ Council: _____________

Registered Position: __________________________  How long: _________

Other Scouting Positions Held: _____________________________________

Years as adult Scout leader/volunteer: _____   Years as Scout: _____

I have completed the following required training:

    Fast Start (Date):               ___-___-___

    New Leader Essentials (Date):    ___-___-___

    Leader Specific Training (Date): ___-___-___

I am an alumnus of the "old" Wood Badge course:  No  Yes (circle one)

    Date: ___-___-___  Council: __________________ Patrol: _________
 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 

Occupation: ________________________________________________________

Date of Birth: ___-___-___    Gender:   M    F  (circle one)

Physical Limitations:   No    Yes  (If Yes, attach description)
Dietary Restrictions:   No    Yes  (If Yes, attach description)
 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 

THE COST OF THE COURSE IS $210, WHICH IS PAYABLE AT LEAST 30 DAYS 
BEFORE THE BEGINNING OF THE COURSE (by August 10, 2009).

***NO REFUNDS AFTER August 10, 2009***

A $50.00 deposit is required to register your application.

Mail application and deposit or full payment to:

Ore-Ida Council, BSA
8901 W Franklin Rd
Boise, ID 83709-0638