*Scout's Name                                                                                                                                                     

(If more than one scout in the family, please list each of their names and ranks separately)

*Pack Number                                                                         *Rank                                             

*Total number of attendees in your family group:                                                                   

*Total number of children in you family group:                                                                         

*Any registered Adult Leaders in your family group?

Please list the names:                                                                                                                       

Make checks payable to: East Carolina Council

*Mail your check and this form to:

         Jane Treon, 408 Glory Rd., Beaufort, NC 28516

**Pre-registration of $15.00 is due postmarked no later than October 11th. Gate registration will be $20.00 per family.