2015 LLD registration form

Shinnecock Lodge
Order of the Arrow
Suffolk County Council
Boy Scouts of America
Dear Brother,
Each year, the leaders of Shinnecock Lodge gather for a Lodge Leadership Development
event. The purpose of the event is to build the team of lodge leaders who will guide our
lodge for the coming year. The event consists of a number of training sessions that will help
us all focus our attentions on issues our lodge needs to again attain the National Quality
Lodge distinction.
You, as a valued member of Shinnecock Lodge, are invited to participate at this exciting
event. As a leader, you know that your attendance is vital to your success in the coming
year.
Here are the details:
Begins:
Ends:
Location:
Registration:
Cost:
What to bring:
Saturday, March 28, 2015 at 10:00 a.m.
Sunday, March 29, 2015 at 12:00 p.m.
Schiff Scout Reservation
Fill out attached form and send into council
$25.00 with a late fee of $30.00
Pen, notebook, uniforms, sash, equipment for an overnight in a cabin
and the willingness to learn
If you have any questions, please email me at [email protected]
Our new lodge leadership team is looking forward to seeing you at the event and working
with you during the coming year.
Yours in Wimachtendienk,
Liam Gargiulo
Lodge Vice-Chief
Training Chair
Shinnecock Lodge 360
2015 Lodge Leadership Development
Member Information
Please print all information clearly.
Name: ______________________________________________ Date of Birth: _____ / _____ / _____
Address: ___________________________________________________________________________
City: ___________________________________________ State: _______ Zip Code: _____________
Email Address: _____________________________________ Phone No: _______________________
Unit #: __________
District: ________________________
Special Needs/ Dietary Restrictions: _____________________________________________________
LLD Information
Where: Schiff Scout Reservation, 1606 Wading River Manor Rd Wading River, NY 11792
Start: Saturday, March 28th at 10:00am
End: Sunday, March 29th at 12:00pm
What To Bring: Class A Uniform and sash, notebook with a pen/pencil,
Equipment for an overnight campout in a cabin.
LLD Fee: $25.00 Late Fee: $30.00 (if received less than 1 week prior)
• Fee includes: Lunch, Dinner, Breakfast, and all other materials for trainings.
• Make checks payable to SCC BSA, or fill out the credit card authorization.
Mail or email this completed form, your payment, and a BSA Medical Form (Parts A & B) to:
Shinnecock Lodge 360
Suffolk County Council, BSA
7 Scouting Blvd.
Medford, NY 11763
[email protected]
I authorize Suffolk County Council, BSA to charge my credit card the induction fee:
Cardholder’s Name: ____________________________________________________________
Address: _____________________________________________________________________
City: _______________________________________ State: ________ Zip Code: __________
CARD NUMBER: ________________________________________ EXP DATE: ___________
Security Code (3-4 digits): __________
Cardholder’s Signature: ___________________________________________________
Please have BSA Medical forms part A and B