SOUTH METROPOLITAN REGION

1 CARRINGTON AVENUE, HURSTVILLE

PHONE: 9570 4525 FAX: 9580 6286

Region Gathering 2017

REGISTRATION FORM

GROUP:DISTRICT:

“Office use only”
Name / Membership Number / J,C S, V, G, R or L / Parent / PED / PED / Membership
Attached / On File / No. Checked
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling
LeaderCubScoutVenturerRover / ParentSibling

Total Scouts @ $45.00 $

Total Venturers@ $45.00 $

Total Cubs @ $45.00 $

Total Joeys @ $10.00 $

Total Rovers @ $45.00 $

Total Leaders @ $45.00 $

Total Parents/Supports @ $45.00 $

Total Cub & Joeys and Leaders Visitors Day @ $10.00 $

Total Parents and others Visitors Day @ $0.00 – must be listed

Total$

(Please make Group cheque payable to Scouts Australia – no personal cheques)

Parentsattending must have a signedM5 formregistered at the Region Office or attach Signed current M5 form to this registration.

Leader in Charge : Phone:

Email address

Booking form and one Group payment are due at the Region Office by the 19th May 2017

Please note that there will be no refunds given after Friday the 26thMay 2017 exceptions in an emergency

Please also note that photographs may be taken of members at this event for publicity reasons.

Office Use Only: Date: ……………………Receipt No: ………………………..Amount: $………………………

Amended 13/4/17