АНКЕТА ДЛЯ ЧЛЕНІВ БУЛАВИ - 2017
на пластовий лещетарський табір для юнацтва Gore Mountain, North Creek, NY
Я є: *
Are you a Male or Female?
Required
пл. ступінь *
Must be registered and have dues paid.
прізвище *
Last name in Ukrainian
Your answer
ім’я *
First name in Ukrainian
Your answer
Last Name *
Last name in English
Your answer
First Name *
First name in English
Your answer
e-mail *
Please enter an e-mail you will check most frequently
Your answer
e-mail confirmation *
Буть ласка ще раз записати бо може бути помилка. Please confirm your e-mail.
Your answer
Cell Phone number *
Area code and number - Numbers only, no dashes or parenthesis please.
Your answer
Home phone number *
Area code and number - Numbers only, no dashes or parenthesis please.
Your answer
Address *
House number/ apt # and Street Name
Your answer
City *
Your answer
State or Province *
Your answer
Zip Code / Postal Code *
Your answer
Дата народження (Birth date) *
Minimum age = 18, maximum age = 200. (MM/DD/YYYY) Please type in the correct YEAR...Current year is the "default" and if you were actually born in the current year then you shouldn't be applying. Thanks!! :)
MM
/
DD
/
YYYY
Рік народження (CONFIRM Birth year) *
Please enter your birth YEAR... just in case you made a mistake. Thanks!! :)
Your answer
Де ти ходиш до школи? або де ти працюєш?
University Name? or where do you work?
Your answer
Студії або професія
What are you studying? Or what is your occupation?
Your answer
Курінь *
Are you a member or candidate of a Plast Kyrin? If so, which one?
Your answer
станиця *
What Stanytsia do you belong to?
Розмір сорочки: *
t-shirt size
ТАБОРОВИЙ ДОСВІД - Подати останних 5 таборів від найновішого
Please list the last 5 camps you attended. Where? Year? what kind of Camp? your role in the camp?
Your answer
ВИХОВНА ПРАЦЯ В СТАНИЦІ
Please provide the years and which Улади (УПН; УПЮ) you worked with.
Your answer
ПЛАСТОВІ ЛЕЩЕТАРСЬКІ ТАБОРИ
Відбув(ла) лещетарський табір в? Years you attended ski camp and your function.
Your answer
РІВЕНЬ ЇЗДИ НА ЛЕЩЕТАХ
What is your sking ability?
РІВЕНЬ ЇЗДИ НА Дошці?
Snowboarding ability?
ПОЗИЧЕННЯ ВИРЯДУ *
Equipment rentals. Please remember that HELMETS are a requirement for all.
Required
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