Please print out this form on your printer, fill it out and mail it with your contribution to Tidewater Council, BSA, 1032 Heatherwood Drive, Virginia Beach, Va. 23455 Make checks payable to Tidewater Council, BSA. Thank you! 2012 Friends of Scouting enrollment form
Your name _____________________________________________________________
Your address ___________________________________________________________
City, State and ZIP Code _________________________________________________
Work telephone ____________________ Home telephone ____________________
Your Scouting information
Indicate the numbers of all units or districts with which you are associated so that we can credit them for recognition.
Cub pack _______________________________
Boy Scout troop _________________________
Varsity team ____________________________
Sea Scout ship __________________________
Venturing crew ___________________________
Exploring post ___________________________
District _________________________________
Council ________________________________
Please list your child(ren) in the Scouting program ______________________________
________________________________________________________________________
________________________________________________________________________
Credit card information (MasterCard or Visa only)
Card Number _____________________________________________________________
Expiration Date ___________________________________________________________
Signature _____________________________________ Date ______________________
Matching gift information
_____ My employer makes matching gifts
Employer's name: _______________________________________________________
Some employers have a matching gift program for qualified 501(c)(3) tax-exempt organizations. Please send the information on your employer if they do make matching gifts.
Friends of Scouting gift levels
_____ $48 -- Supporter
_____ $120 -- Advocate
_____ $173 -- Cost per Youth
_____ $366 -- Dollar a Day_____ $750 -- Star Level
_____ $1,250 -- Life Level
_____ $2,500 -- Eagle Level
_____ $ _________ -- Other
_____ Please use the whole gift for Scouting, as I decline recognition.Payment preferences
This information tells us how many times to send you statements. All payments are due by December 31, 2012
_____ Annually
_____ Semi-Annually
_____ Quarterly
_____ Monthly
_____ Bill now
Today's date _________________________
The Tidewater Council, BS is a 501(c)3 registered with the Commonwealth of Virginia, with the Department of Agriculture and Consumers and holds a bona-fide certificate to raise funds as a not-for-profit organization. The council is also registered in the State of North Carolina.