September 2011
Page 1
BOY SCOUT TROOP 85
Annual Dues and Registration
INSTRUCTIONS
All Scouts and adult leaders must renew their registration each year with the Troop and the Boy
Scouts of America
The Troop collects annual dues that are needed to operate the troop and support its activities
The Troop updates its database of information about its scouts and adult leaders
Please attach a copy of Insurance ID Card
Complete the Dues and Registration Form (the reverse side of this page):
List the scouts and adults to be registered again for 2011-12; the Troop dues includes all fees that the
Troop will pay to our BSA Council
Select a subscription to Boys’ Life (optional) and pay your Order of the Arrow dues, if applicable
Identify any scouts or adults who should be deleted from the Troop’s registration; this helps us keep
our lists up to date
Calculate the total payment due to the Troop
Take the forms and your payment to a troop meeting (give it to Mr. Charles Dow) or
mail it to the address below.
You can also find the form on the troop website ( )
.
A scout or adult will not be registered for 2011-12 without full payment to the Troop.If you need helpwith the payment, contact Scoutmaster Mark Antoniak about confidential scholarship assistance.
If an adult listed on your Dues and Registration Form has not submitted a BSA adult application
form previously, then he/she must complete one and submit it with the troop dues. The form can
be found online at:
Scouts who will turn 18 year old before January 31, 2011 and wish to register as an adult leadermust submit a completed BSA adult application with their dues.
All registered adult leaders must comply with the Adult Leader Code of Contact.
As part of this year’s registration process, we will be tracking the training completed by each Adultto assist with the record keeping maintained by the Adult Training Coordinator. Please reviewand complete the form included as page 3 and turn in with your registration form (page 2) andpayment.
Return all form and dues payment no later than OCTOBER27, 2011:
Mail them to: Or turn them in at a troop meeting
Mr. Charles Dow - Treasurer
35 Meadow View Drive
Wethersfield, CT 06109
September 2011
Page 2
BOY SCOUT TROOP 85
2011-12 Troop Dues and Registration
The annual dues for scout registration are $50.00 for the first scout in a household and $40.00 for each additionalscout in the same household. The annual dues for adult registration are $15.00 per person.
Boys Life Magazine (optional) is $12.00 for a one-year subscription. Mark an “X” below for each subscription.
Scout Registration
(Optional)
Scout’s Name Dues Boys Life (X) Total
1st ______$50$12 ( ) ______
2nd ______$40 $12 ( ) ______
3rd ______$40 $12 ( ) ______
Adult Registration Adult registration is optional, but adults must be registered with BSA to stay
overnight on a campout or attend summer camp, and must sign an Adult Leader Code of Conduct form(this is an annual requirement
Adult’s Name Dues Boys Life (X) Total
1st ______$15$12 ( ) ______
2nd ______$15$12 ( ) ______
3rd ______$15$12 ( ) ______
If a person named above has not registered previously as an adult with Troop 85, he/she must complete a
BSA adult application form. The form can be found online at
Scouts who turn 18 years old by January 31, 2011 and wish to register as an adult leader must complete a BSAadult application form.
Payment Due Please enclose check payable to “BSA Troop 85” Total Due = ______
Deletions Please DO NOT register the following scouts and adults:
1. ______3.______
2. ______4.______
You may also let us know this by simply sending an e-mail to . Thank you forhelping keep our lists up to date.
Return Forms and Dues Check (payable to BSATroop 85)
Please return this form and your payment by OCTOBER27, 2011(at meeting)
Or by Mail:
Mr. Charles Dow - Treasurer
35 Meadow View Drive
Wethersfield, CT 06109
Questions: Contact Mark Antoniak at
September 2011
Page 3
ADULT TRAINING CHECKLIST
Please take time to complete the following checklist to support an update to our records for Adult training that iscomplete. TURN THIS IN WITH YOUR REGISTRATION SHEET (PAGE 2) AND PAYMENT.
TRAINING DESCRIPTION Check if Complete Date (if known)*
Boy Scout Leader Fast Start ______
Youth Protection ______
This is Scouting ______
Scoutmaster/Assistant Scoutmaster Leader Specific ______
Introduction to Outdoor Leader Skills ______
Troop Committee Challenge ______
(required for Troop Committee Member/Committee Chairman)
*Approximate date or month/year is fine. Fast Start, Youth Protection and This is Scouting dates may be
available via your MyScouting.org on-line account, if completed on-line.
ADULT - TRANSPORTATION INFORMATION
Please supply the following information concerning driver’s license and auto insurance, if you are a driver for anytroop activity. This information will be utilized only in the unfortunate case of an auto accident in route to, orreturning from an activity. All drivers must take Youth Protection Training.
Driver’s License:
Issuing State:______License Number:______Expiration Date:______
Auto Insurance:
Insurance Company:______Policy #:______