Mail to: Chief Pontiac Programs Committee
Dept: CPT
P.O. Box 272, Highland, MI 48357-0272
Phone: (248) 563-7428 Fax: (248) 232-1531
www.chiefpontiacprograms.org
*Leader name: / *Council: / *Unit # & type:
*Address: / *City: / *State: / *Zip:
*Phone: / E-mail:
Trek Leader Name & Phone if different from above:
Indicate type of trek: 2 day Hike Trek Canoe Trek Winter Trek
Trek Dates: / Proposed Court of Honor Date: / Location:
Notes Please indicate proposed trek step off time:
Instructions for completing this form:
Insert the Name, Rank and Age of the individual participants. (REQUIRED) Note: To earn the credential medal hikers must be First Class Rank or above.
This is a high adventure type activity and BSA guidelines as to age and ability should be followed.
Insert the Medal Serial Number for any repeat hikers, and insert "New" for new hikers that have never received a CPT credential medal. Inset “PENDING” if a CPT trekker has previously hiked the CPT but has not received their Serial Numbers medal and is undertaking a second trek before the COH award is received from the first trek.
For the Gray #, Blue # or White # columns: Insert the numbers on the Arrow head pins that the participant currently has. Insert N/A for new hikers or for participants that do not have that color pin.
For participants that are hiking on the trek but do not want a medal or pin, but want the Pioneer patch, leave all spaces after "Age" blank.
The remaining columns are for your use for tracking purposes.
Note: In keeping with minimum impact camping practices, a maximum permitted crew size is 12 people total.
An appropriate tour permit must be filed and approved by your council before this activity. A copy must be presented to your CPT guide at the trailhead.
Name
First name, Last name / Rank / Age / Medal Serial # / Hike Gray # / Canoe
Blue # / Winter White # / Chief Pontiac report / Trek / Trek
Report / Map Sketch
A $25.00 non-refundable deposit is required when you submit this form. Total fees can be paid when mailing the crew’s final Trek Report & Map Sketch package. The $25.00 deposit should be accounted for if you submit total fees with your after-trek reports. Trek Award fees are traditionally received at the Court of Honor when trek awards are formally presented
Deposit Received: Amt: / Date: / Receipt #: NOTE: The Registration Fee of $25.00 is non-refundable **No. of repeat hikers / X $20.00 = / *No of new hikers / X $30.00 = / *No of Pioneer hikers / X $4.00 =
New Hiker fees: / + Repeat Hiker fees: / + Pioneer fees / =Awards $ / $25.00 deposit* = Total Fees
Total $ enclosed for items: (New medals=$30.00 ea., Repeat=$20.00 ea., for 2018 includes 60TH Anniversary Patch $5.for every Hiker; + Pioneers = $4.00:
Please make your check for payment of the CPT award fees to : “CHIEF PONTAC PROGRAMS COMMITTEE”
*Complete all of these areas. Questions contact the Chief Pontiac Trail Comm.@ Web page: www.chiefpontiacprograms.org
Questions:? Send e-mail to info@. Ref: form date: 09/01/2017