Adult Application

Your Formal Name *

First

Last

Name you are know by: *

Home Troop # *

Main Contact Phone Number *

Can we text this number? *

YES NO

Phone Number belongs to: *

How many years of MISST service. *

What Merit Badges do you councel? *

1st Alternate Phone Number *

Can we text this number? *

YES NO

1st Altenate Phone Number belongs to: *

2nd Alternate Phone Number *

Can we text this number? *

YES NO

2nd Alternate Phone Number belongs to: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

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

Spouse's Name *

First

Last

Spouse's Email *

Emergency Contact Name *

First

Last

Phone Number *

Can we text this number? *

YES NO

Relationship *

Home Troop Position *

Home Scoutmaster or Committee Chair *

Phone Number *

Can we text this number? *

YES NO UNKNOWN

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 ather Extra Curricular Activities you are involved with *

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

List Positions Held on the Island *

Check if you are you certified in: *

CPR First Aid

The information above is required for all applying to go to Mackinac Island for this season.

gIVE THREE REFERENCES:

additional information:

Make any additional comments and/or upload a more detailed letter.