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PLEASE COMPLETE ALL INFORMATION

Outpost # __________Church _______________________Church Phone (____) _______________

Church Address_______________________________________________________________________

Sr. Commander _________________________Home Phone (____) ____-________________________

$100/person PRE- REG. Due June 1       $120/person LATE PRE-REG  Due June 15

$130.00/ person  after June 15 or at the door.

15% DISCOUNT FOR A CHARTERED OUTPOST (For the number of men and boys chartered.)

# of Discover Rangers______________

# of Adventure Rangers______________                                                           

# of Expedition Rangers______________

# of Leaders______________

                 TOTAL             _____________   X  $20.00  =$__________________     

                                                                                             Amount of pre registration check.

MAKE CHECKS PAYABLE TO:   “NY DISTRICT ASSEMBLIES OF GOD”  

IN THE MEMO OF THE CHECK WRITE THE WORDS: “ROYAL RANGER POW WOW

MAIL CHECKS AND THIS FORM TO:    NY DISTRICT A/G

                                                        8130 OSWEGO ROAD,    LIVERPOOL, NY 13088-0039

Pre Reg - ENVELOPES MUST BE POSTMARKED BY June 1, 2011.

Late Pre Reg – ENVELOPES MUST BE RECEIVED BY June 15, 2011

 [     ]  I HAVE LISTED THE NAME (S) OF PERSONS WITH SPECIAL FOOD NEEDS ON THE

BACK OF THIS PAGE.  I HAVE INCLUDED THE FOOD CONCERN FOR EACH PERSON.

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