Adult Application

ADULT APPLICATION 2023
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Your Formal Name *

First

Last

Name you are Known by: *

Home Troop # *

Main Contact Phone Number *

Phone Number belongs to: *

How many years of MISST service. *

What merit badges do you counsel? *

Your Email: *

1st Alternate Phone Number *

1st Alternate Phone Number belongs to: *

2nd Alternate Phone Number *

2nd Alternate Phone Number belongs to: *

Spouse's Name *

First

Last

Spouse's Email *

Phone Number *

ADDRESS *

Line 1

Line 2

City

State

Zip Code

Country

List any Medical, Dietary, or Food allergy we should be aware of. *

Emergency contact name: *

First

Last

Relationship *

Phone Number *

Home Troop Position *

Home Scoutmaster or Committee Chair *

Phone Number *

Birth Date:

Month *

Day *

Year you were born. *

Why have you decided to participate in the Mackinac experience.. *

What do you expect to gain from the experience? *

List Leadership Positions held in your home troop. *

Scouting Awards *

Order of the Arrow Membership and offices *

Scouting Training (Courses taken and dates) *

List any other Extra Curricular Activities you are involved with *

If you served at Mackinac Island what were the years you attended? *

List Positions Held on the Island *

Check if you are you certified in: *

CPR First Aid

List Three References.

Ref. 1 NAME *

Phone Number *

Ref. 2 NAME *

Phone Number *

Ref. 3 NAME *

Phone Number *

I agree to receiving marketing and promotional materials *

Submit

ADULT APPLICATION 2023* Required field

ADULT APPLICATION 2023
* Required field