Individual Registration

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For Scouts:
First Name *
Middle Name		Last Name *
Gender *	Male Female
Email Address *
Address Line 1		Address Line 2
City *		State *
Zip/Postal Code *
Country if other than USA

Stage Level/Scouting Rank: *
Active *	Yes No
If No when
Den/Pack/Troop: *
Leader Name:
Jain Center/Society
Best way to contact
Parent(s)
(please complete even if not receiving an award)
Name *
Relationship to Student
Address
Best way to contact
Send award and certificateSend award and certificate to parent(s)	Yes No
Spiritual Leader:

Name
Address
Best way to contact
Send award and certificateSend award and certificate for Spiritual Leader	Yes No

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