Payment can be made at the time of the event for both Scout Badge-Day Workshops and Homeschool Days

Please print clearly.

Name:_______________________________________________________________

Mailing Address: )______________________________________________________

City: ___________________________________ State:________ Zip: ____________

Daytime Phone: ______________________________________________________

Message Phone:_______________________________________________________

E-mail Address: _______________________________________________________

School/ Org: _________________________________________________________

Age Levels or Grades Taught: ____________________________________________

What workshop or event are you registering for: _____________________________________

Amount of Payment Enclosed: ____________________________________________