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Your Name
   
 
 
 
Which of the following are you interested in?
 
Civil Air Patrol
 
Young Marines
 
Boy Scouts
 
Girl Scouts
 
Cub Scouts
 
Law Enforcement Explorers
 
Other
 
 
 
On a scale of 1- 10 how are you at
1 2 3 4 5 6 7 8 9 10 N/A
Working with other people
Physical Challenges
Being Motivated to do stuff out of you comfort zone
 
 
 
What is your current income (or put classified if you don't know)
   
 
 
 
I am going to be a:
 
Senior Member
 
Explorer/Cadet
 
 
 
What do you plan to use the money received for (uniforms, annual dues, etc.
   
 
 
 
Amount requested
   
 
 
 
E-mail adress
   
 
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