Participant’s Name: _______________________________________________________
Address: ________________________________________________________________
City: ________________________________________________ State: _________ Zip: _________
Phone: (______) __________________________ Unit: Troop_________ Venture Crew: ________
Choose one: Youth participant __________ Adult participant: __________
Chapter: Sakima Machque (Eastern District) if other, write in district or chapter: ________________
Status (clearly mark one): Ordeal Candidate Ordeal Member
Brotherhood Candidate Brotherhood Member Vigil Honor Member
Specify Event by circling :
Ordeal at Kia Kima August 8-10 posted by July 18
Ordeal at Sardis August 22-24 posted by August 1
Fall Fellowship (for OA members at that time) Sept 19-21 Tallaha posted by August 1
Family Banquet November 15 at McLemore posted by Oct 1
Event Fees: $15 for ordeal participant, add $20 if an Ordeal or Brotherhood candidate, add $10 late if if arrival after post date, Fall Fellowship fee is $20/ participant, Family Banquet is $8/participant
Make checks payable to Chickasaw Council and note event on check- OA Event Registration, 171 South Hollywood, Memhis,TN 38112.
Visa, MasterCard, Discover, & Amex accepted call council office for instructions
Council fax number: 901-327-2010