| Troop Number: _______________________________________________ |
| Scout Leader Name: __________________________________________ |
| Contact Telephone #: ________________________________________ |
| Number of Scouts attending session #1: ______________________ |
| Number of Scouts attending session #2: ______________________ |
| Total prepaid fee paid: _____________________________________ |
| List Boy Scouts Name | Pick up to four(4) Merit Badges to work on. |
| ____________________ | 1. ___________________ | 2. ___________________ |
| 3. ___________________ | 4. ___________________ |
| ____________________ | 1. ___________________ | 2. ___________________ |
| 3. ___________________ | 4. ___________________ |
| ____________________ | 1. ___________________ | 2. ___________________ |
| 3. ___________________ | 4. ___________________ |
| ____________________ | 1. ___________________ | 2. ___________________ |
| 3. ___________________ | 4. ___________________ |
| ____________________ | 1. ___________________ | 2. ___________________ |
| 3. ___________________ | 4. ___________________ |
| ____________________ | 1. ___________________ | 2. ___________________ |
| 3. ___________________ | 4. ___________________ |