Jamboree Registration Form Jamboree Registration Troop Leader's Name* First Last Troop #*Troop Level*DaisiesBrowniesJuniorsCadettesSeniorsWhich program are you registering for?*Jamboree Weekend for Juniors and Cadettes, March 17 - 19, 2017Jamboree Weekend for Seniors and Cadettes, February 23 – 25, 2018Jamboree Weekend for Brownies and Juniors, November 3 - 5, 2017Estimated # of Scouts Attending:*Estimated # of Chaperones Attending:*Leader's Email* Leader's Phone*Leader's Mailing Address* Street Address 1 Street Address 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Accessibility requests?Are there any accessibility requests that any of the members in your group need? Any additional things you would like us to know?Food AllergiesHow did you hear about our Programming?*Were you referred by another Troop Leader?* Yes No If yes, name of Troop Leader and Troop #Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Registration Fee* Price: $180.00 PhoneThis field is for validation purposes and should be left unchanged.