NYLT Bristlecone 2013
Adult Contact Information- For Credit Card
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First Name
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Last Name
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Address 1
Address 2
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City
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State
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Zip
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Email Address
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Phone
Participant Information - List each
First Name
Last Name
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Email Address
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Phone
Unit Number
Unit Type
Pack
Troop
Team
Crew
Post
Distict
Council
Out of Council
District
Coyote Creek
Quicksilver
Pioneer
Polaris
Outreach
Council
Out of Council
Council
Santa Clara County
Pacific Skyline
Monterey Bay Area
Alameda
Piedmont
San Francisco Bay Area
Other
Participant Fee - balances for payment before May 31, 2013
Full Fee payment @ $250
Payment After deposit @ $200
Deposit @ $200
Participant Fee - balances for payment after May 31, 2013
Full Fee payment @ $275
Payment After deposit @ $225
Deposit @ $50
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Convenience Fee for online credit card use - VISA/MasterCard:
2.00%
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Indicates Response Required