THIRD ANNUAL KLAHAYA DISTRICT
KLONDIKE DERBY
JANUARY 20, 2001

REGISTRATION FORM PACK/TROOP # _______________________

Leader in charge _________________________________________

Phone _______________Email _____________________________

We will have ______ Webelos Patrols

We will have ______ Scout Patrols

Enclosed are our fees for the Klondike

_____ Scouts (Webelos) X $5.00 = $ ________

_____ Adults who want a patch X $2.50 = $ ________
(Adults working at a Klondike get a free patch)

_____Late Fee of $10 or $20 ? = $ ________

Total $ ________

Registration due by January 10th....A Late fee of $10.00 will be charged for registrations after the 10th and a fee of $20 will be charged if unit registers the day of the event. Refunds will be made for up to 4 Scouts or Adults if notified the day of the Derby.

ACCIDENT INSURANCE # ________________________

Make checks payable to Mt Baker Council, BSA
(Bring your receipt to the Derby...Patches will be distributed at Derby)

(IF WE RUN SHORT OF PATCHES WE CANNOT REORDER, SO THOSE WHO PAY FIRST WILL GET THEIR PATCHES FIRST)

Mail or deliver to Klondike Pete
Mt Baker Council, BSA
1715 100th Pl SE
Everett, WA 98205

******************************************************************
Office Notes