Revised: 1/7/99
Troop 55 Blue Ridge Scout Reservation
Sign me up! I want to go to Blue Ridge with Troop 55, June 20-26, 1999! Enclosed is my deposit of $100 payable to "Troop 55" (refundable until 2/1/99)
(please print clearly!)
Name_____________________________ Circle one: Scout Adult
Scout's Birthdate ______________ Age_____
Scout's Rank__________________Scouts Age 13 by 6/20/99: I'd prefer (circle one):
- High Knoll Trail backpacking adventure
- New River whitewater adventure
- Mountain Man adventure
- Merit Badge camp
Parents' Name_______________________
_____________________________________
Street Address, City, State, & Zip Code
Home Phone:_______________ Office phone:_______________Scout's e-mail_______________________
Parents' e-mail_______________________
FAX_______________________
Balance of fees, about $300, will be due by March, 1999. Return this form to:
Ken Alexander Porter & Hedges, L.L.P. 700 Louisiana Houston, TX 77002-2764 FAX: 713-226-0214 e-mail: nkalexander@porterhedges.com Phone: 713-226-0614