Contact First Name:
Contact Last Name:
Type of Scout:	Tiger Wolf Bear Webelo Boy Scout Daisy Brownie Junior Cadette Senior
Pack/Troop #:
District:
Address:
City:
State:	Florida Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Phone:	(Home)
	(Alternative Phone)
Email:
Date of Event:
Time of Event:	11:00 AM 3:00 PM
Type of Program:	Fly Fishing Merit Badge Fishing Merit Badge Fishing Belt Loop Wildlife Conservation Belt Loop EPA Water Drop Water Wonders Badge Wildlife Badge Florida Wetlands Project Enviromental Science Merit Badge Soil & Water Conservation Merit Badge Program Fishing Clinics for Girl Scouts
# of Scouts: (A 20 scout/child minimum is required)
# of Additional Children:
# of Additional Adults*:
* 2 Leaders per Pack/Troop are FREE!!! You are NOT confirmed until an IGFA staff member contacts you.

BALANCE DUE THE FRIDAY ONE WEEK PRIOR TO EVENT DATE

All payments are non-refundable and non-exchangeable.  Cancellations must be made at least five working days prior to the event. If a program is cancelled by IGFA, a full refund will be issued.  No other conditions for refunds apply.  Payments may be made by cash, credit card or check made payable to IGFA.