[Lodge230] Fall Fellowship

[Charles M. Owen]

This form is on the Lodge Website under "Forms -> Calendar Downloads"

-----Original Message-----
From: lodgenews-bounces at pellissippilodge.org
[mailto:lodgenews-bounces at pellissippilodge.org] On Behalf Of Randy Stevens
Sent: Thursday, August 27, 2009 8:46 AM
To: Lodge Email Distribution List
Subject: [Lodge230] Fall Fellowship

"Greek..Home of the Spartans"
Pellissippi Lodge Order of the Arrow
 
Fall Fellowship
At Camp Buck Toms
Sept. 18-20, 2009
 
Fall Fellowship is approaching swiftly!
There will be FUN, New Olympic quest games,
and Ultimate Frisbee & "Lodge Ball"  Tournaments.
 
Enjoy good food and strengthen bonds of brotherhood.
So, come out to Camp Buck Tom's for a 
Great Weekend with the Order of the Arrow. 
 
Cost: $32 Early Registration (received or postmarked by Sept. 11)
$42 Late Registration (after Sept. 11) & Walk-On
(All prices are included with 2009-2010 dues. $7 per year)
 
Mail this form to:
Pellissippi Lodge OA Fall Fellowship 2009
Great Smoky Mountain Council
PO Box 51885
Knoxville, TN 37950-1885
 
For More Information, Contact:
Joseph Stombaugh
oa.drummer at yahoo.com
(865)-742-4843 
 
Name: ______________________________________ Date of Birth: __ __ / __ __ /
__ __ __ __
Chapter: ____________________________ Honor Level (circle and put dates): 
 
Ordeal __/__/__ Brotherhood __/__/__ Vigil __/__/__
I am (circle one): Male / Female
Email Address: ____________________________________________ [] Check to
receive Lodge News
 
Guardian Name: ______________________________ Phone # (__ __ __) __ __ __-__
__ __ __
 
Home Address: ________________________________________ Phone # (__ __ __)__
__ __-__ __ __ __
 
City: ___________________________ State: __ __ Zip: __ __ __ __ __ BSA Id #:
__ __ __ __ __ __ __
 
Health Concerns/Allergies:
________________________________________________________________
I give permission for full participation in BSA programs, subject to
limitation noted herein. In case of emergency, I understand every effort
will be made to contact me (if adult participant, my spouse, or next of
kin). In the event contact cannot be reached, I hereby give my permission to
the licensed health-care practitioner selected by the adult leader in charge
to secure proper treatment, including hospitalization, anesthesia, surgery,
or injection of medication for my child (or for me, if participant is an
adult).
 
Date: __ __ / __ __ / __ __ Guardian /Adult Signature:
__________________________________________
**Please attach a BSA class 1 health form**