AH'TIC LODGE #139 ORDER OF THE ARROW ANNUAL DUES and MEMBERSHIP REINSTATEMENT PAYMENT FORM   Please print and provide all information requested on this form and return to:   Bob Billick OA Lodge #139 Membership Advisor 602 Oak Street Ridgeway PA, 15853

 

NAME:_____________________________________TYPE OF MEMBER   YOUTH___ADULT___

 

ADDRESS:________________________________________________________________________

 

CITY, STATE, ZIP:_________________________________________________________________

 

PHONE: (H)_______________(W)_______________EMAIL:_______________________________

 

DATE OF BIRTH:____________________ UNIT #_________DISTRICT______________________

 

MEMBERSHIP CATEGORY AND DATE:

ORDEAL:__________________BROTHERHOOD:_________________VIGIL:_________________

 

Your annual dues are the lodge's main source of income.  It is once again time to renew your dues and help our lodge continue our service to Scouting.  Our dues for the year are only $10, however, if you pay early (prior to October 30), you can pay the early bird price of just $8.  Thank you for continuing your membership in our great and honored Order of the Arrow Lodge.

 

PAYMENT:   Early Bird $12:____________Reg. $15:___________Reinstate $15:___________

 

PAYMENT METHOD: Ck#_______________Cash:______________DATE:______________

If your dues are not paid by December 31of this year we will be forced to drop you from our active rolls and you will not recieve any mailing.  We need ALL our brothers so don't let this happen.

 

Please place a check mark by any committee or skill you may have or want ot serve on so that the Chairman can cantact you for actives.

____Activities	____Carpentry
____Dance/Drum	____Computer
____Conclave/NOAC	____Electrical
____Ceremonies/Inductions	____Engineering
____Communications/Newsletter	____Plumbing
____Fellowship	____Other
____Membership	____CDL (specify)
____Service	____Hvy. Equip (specify)
____Awards and Recognition	_______________________