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High Desert Council

Date

Month

Day

Year

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

OA Status

Existing Member

Transferring Member

BSA ID #

YPT Date

Date of Ordeal

Brotherhood date

Vigil Date

Dues are $15. (Please consider adding the 3% credit card transaction fee that the OA must pay. Your total would be $15.45)*

$

Albuquerque Office

5841 Office Blvd. NE

Albuquerque, NM 87109

505-345-8603

El Paso Office

7601 Lockheed Drive

El Paso, TX 79925

915-772-2292

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