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ADULT APPLICATION 2019
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Required field
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Indicates required field
Your Formal Name
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First
Last
Name you are Known by:
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Home Troop #
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Enter T-xxxx, where xxxx is your Troop Number
Main Contact Phone Number
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Phone Number belongs to:
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How many years of MISST service.
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What merit badges do you counsel?
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Your Email:
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1st Alternate Phone Number
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1st Alternate Phone Number belongs to:
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2nd Alternate Phone Number
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2nd Alternate Phone Number belongs to:
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Spouse's Name
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First
Last
Spouse's Email
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Phone Number
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ADDRESS
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Line 1
Line 2
City
State
Zip Code
Country
List any Medical, Dietary, or Food allergy we should be aware of.
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Emergency contact name:
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First
Last
Relationship
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Phone Number
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Home Troop Position
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Home Scoutmaster or Committee Chair
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Phone Number
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Birth Date
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Month
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January
February
March
April
May
June
July
August
September
October
November
December
Day
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1
2
3
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19
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28
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Year you were born.
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Type the year you were born.
Why have you decided to participate in the Mackinac experience..
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What do you expect to gain from the experience?
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List Leadership Positions held in your home troop.
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Scouting Awards
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Order of the Arrow Membership and offices
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Scouting Training (Courses taken and dates)
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List any other Extra Curricular Activities you are involved with
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If you served at Mackinac Island what were the years you attended?
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Example: 2004, 2005 or 2004-2009
List Positions Held on the Island
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Check if you are you certified in:
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CPR
First Aid
List Three References.
Ref. 1 NAME
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Phone Number
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Ref. 2 NAME
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Phone Number
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Ref. 3 NAME
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Phone Number
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I agree to receiving marketing and promotional materials
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