NCALEEA, INC.

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ADVISOR REGISTRATION FORM


2019 NCALEEA AGENCY ADVISOR REGISTRATION FORM


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I. Advisor Information


NAME ___________________________________POSITION IN POST __________________________________ (Advisor; Assistant Advisor; etc...)

E-MAIL : _________________________________________________ PHONE# ____________________ 


Registered/chartered with local BSA/ Learning for Life Office:               YES _______  NO _______

Registered with Public Safety Cadets Organization:                               YES_______   NO_______


II. Agency Information

AGENCY:___________________________________*POST#:_________*LOCAL BSA COUNCIL:_____________________                                                                                                                        *(IF CHARTERED WITH BSA/LEARNING FOR LIFE)*

AGENCY ADDRESS: ____________________________________________________________________________ ______________________________________________________________________________________________

AGENCY PHONE#: ______________________ E-MAIL ADDRESS:___________________________
LEAD ADVISOR: ____________________________________PHONE: _________________(C)________________(W)

LEAD ADVISOR/E-MAIL _____________________________________________________________________

****************************************************************************************************************************************** ANNUAL POST/AGENCY FEE: $20.00

1. BRING REGISTRATION FORMS AND FEES TO THE ASSOCIATION MEETING ON MARCH 7;

2. IF UNABLE TO ATTEND THE MEETING - SEND FEES TO: SERGEANT CH SLUDER-RETIRED, 1105 NEW HAMPSHIRE DRIVE , JAMESTOWN NC 27282, INDICATE 2019 REGISTRATION FEE ON CHECK AND EMAIL COMPLETED REGISTRATION FORMS TO: G KEVIN WYKLE - WSPD at: [email protected]


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