Date _______________
ELLIOTT’S SCOUTS INFORMATION SHEET
NAME: ___________________________________________________
ADDRESS: ____________________________________________________________
____________________________________________________________TELEPHONE: HOME - __________________________________________________
WORK - __________________________________________________
CELL - __________________________________________________
EMAIL - __________________________________________________
BIRTHDATE: __________________________________________________________
SPOUSE: ______________________________________________________________
CHILDREN: ____________________________________________________________
DO YOU WANT TO BE MOUNTED________ OR DISMOUNTED________
IF MOUNTED, DO YOU OWN A HORSE Y N
DO YOU OWN A HORSE TRAILER Y N
Annual Dues $15 for a single person, $20 per family
Make check payable to Elliott's Scouts
Return to Captain Bob Green 37166 W Hwy D Polo, Mo 64671
