HOAC-BSA

Heart of America Council, Boy Scouts of America Logo

Reserve Your Spot for Woodbadge

Select Payment Amount

**Please note, the deposit of $75 must be paid upon sign up for spot in the course to be held.

District Name

Unit Type

Unit Number (0000):

BSA ID#

Participant First Name

Participant Last Name

Mobile Number

Birthdate

Gender

Religious Preference

Occupation

Years in Scouting as Adult

Current Position in Scouting

Position Specific Training Date

Youth Protection Training Date

Medical Training

Years in Scouting as Youth

Highest Rank Earned As Youth

Special accommodations (physical/dietary)

255 character limit

0 / 255

What Do You Expect to Gain from this Course?

255 character limit

0 / 255

T-Shirt Size (One Included)

Purchase Additional T-shirts SM- XL $12 Each

Purchase Additional T-Shirt Size 2XL-4XL $14 Each

First Name

Last Name

Address

City

State

Zip

This is a secure 256-bit SSL encrypted payment

Card Number

Expiration Date

CVV

I would like to cover the payment processing fee.