Klondike Registration Form
Klondike Derby
Online Registration Form
Your Name : Your Phone #:
Your E-Mail address:    
Registration Type:
New Additional Registration
 
Unit Type:
Troop Pack Crew
 
Unit Number:
District:  
Leader in Charge:
Name: Home Phone:
Address1: Work Phone:
Address2: Email:
 
Adults to help at Stations (2 per patrol or den)
Name: Phone:
Name: Phone:
Name: Phone:
Name: Phone:
Name: Phone:
Name: Phone:
Name: Phone:
Name: Phone:
 
Overnight Camping or Day Event: If camping, please specify how many will be camping
Number of Regular Patrols / Dens :
Number of Senior Patrols:
Number of Crews:
Number of Extra Event Patches: $4 each
Total Scouts attending: Cost per Scout includes Event Patch ($10, after Jan 22- $15)
Total Adults attending: Cost per Adult includes Event Patch ($10, after Jan 22- $15)
  Press "Validate Entries" button before proceeding -->  
  Total Registration Fees->
PAYMENT METHOD  
UDA Account The total amount will be deducted from the Unit's UDA account at Council. By pressing the "Register" button below, you have the authority to authorize the Council to make this deduction.  
Credit Card Call Kathy Brooks, 609-419-1600 ext 11, with credit card information today, Unit will be considered registered after credit card transaction has been successfully processed by a Council representative.  
Check

Make your check payable to CNJC and send check today to:
CNJC
Attn: Kathy Brooks- JK Klondike
2245 US Highway 130, Suite 106
Dayton, NJ 08810
Unit will be considered registered after check arrives at Council.