NAME_________________________________________

 

ADDRESS:______________________________________

CITY, STATE, ZIP:________________________________

TELEPHONE:____________________________________

PACK # and DEN:_________________________________

My son: __________________________________________

              has my permission to attend and participate in the               
Cub Scout Rocket Derby.

_________________________________________________

Parent or legal guardian signature




NAME_________________________________________
ADDRESS:______________________________________
CITY, STATE, ZIP:________________________________
TELEPHONE:____________________________________
PACK # and DEN:_________________________________
My son: __________________________________________
has my permission to attend and participate in the Cub Scout Rocket Derby.
_________________________________________________
Parent or legal guardian signature

Sponsored by
Cub Scout Pack 210
Leesburg, Georgia
Saturday, November 5, 2005
Start time: 9:00am
Albany Marine Base


Mail $5.00 entry to Cub Scout Pack 210
1935 Philema Road S.
Albany, Georgia 31701


Checks payable to: Cub Scout Pack 210

Info Darin Erickson

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