Forward before July 1st, 2011

The Maritime Conference cannot recognize or provide insurance
to a local club until registration process is completed.

2011-12 Adventurer Club Yearly  Application

Sponsoring Church________________________________________________

Church Board Member________________________________________________

*Elected  Club Director: ________________________________

Email  Address:(Required)____________________________________________________

Mailing  Address  _______________________________________

_____________________________________________________

Home  Phone____________________________

Work  Phone_____________________________

*We understand the above elected  director or a representative
from the club, is required to attend all  Conference Adventurer sponsored  events.

Signatures:

Church  Board Member:____________________________________

Church Board Member:  ____________________________________

Church Board Member:  ____________________________________

Date:__________________________________________