South Atlantic Conference

SOUTH ATLANTIC CONFERENCE OFFICIAL PATHFINDER CLUB REGISTRATION FORM 2009

Fees: $10.00 per Pathfinder and Staff

Club Name______Church Name______Address______City______State___ Zip______Telephone (____)______Pastor’s Name______Telephone (____)______

Director’s Name______Address______City______State___ Zip______Telephone (____)______

Club Staff Deputy Directors: ______Male____ Female______Male____ Female______Male____ Female______Male____ Female____

Club Members _____ Male____ Female____ TLT Members _____ Male____ Female____ Staff Members _____ Male____ Female____ Master Guides _____ Male____ Female____ Does your club have the following? Drill Team [ ] Yes [ ] No Members _____ Male____ Female____ Drum Corp [ ] Yes [ ] No Members _____ Male____ Female____ Bible Bowl Team [ ] Yes [ ] No Members _____ Male____ Female____ Other: ______Members _____ Male____ Female______Members _____ Male____ Female____ Additional Information: ______

Complete form in triplicate. Mail one (1) copy to the SAC Youth Ministries Department, mail one (1) copy to your Area Coordinator , and keep one (1) copy for your records. (PLEASE TYPE OR PRINT)

South Atlantic Conference Youth Ministries Department P. O. Box 92447 – Morris Brown Station Atlanta, Georgia 30314 Telephone: (404) 792-0535 Extensions 113 or 112 Female (Members) Male (Members)

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Amount Enclosed: $______(NO PERSONAL CHECKS)

OFFICE USE ONLY OFFICE USE ONLY

Date Received ______Club ______State _____ Total Members ______Money Order ______Amount Received ______Check ______Receipt Number ______