2019 AAD/PPXII Board of Review
January 26, 2019
St. Thomas High School

Board of Review Registration Form/Maverick Scout Registration

This form must be received no later than January 6, 2019.

If you are unable to attend the Saturday session and you need a Board of Review earlier than January 26,
please contact Nick Lopez (at nick@lopez.net) to arrange another date. All candidates for the AAD
and Pius XII Emblems must have a Board of Review before the presentation of the Emblems.

Troop/Crew/Ship Number    Chartered to
Counselor/Facilitator Name
E-mail address that you check often:
Please re-enter your e-mail address:
Phone Number: Home

AAD Youth: No    Yes; x $35.00 = $  (if none, specify '00')
PPXII Youth: No    Yes; x $35.00 = $  (if none, specify '00')
Adults: No    Yes; x $ 0.00 = $
AAD Parent Pins? No    Yes; x $ 7.00 = $ (if none, specify '00')
PPXII Parent Pins? No    Yes; x $ 7.00 = $ (if none, specify '00')
 Total Cost: $
Is the adult leadership of your unit current in its applicable Youth Protection Training?
(Completed since February, 2018 per http://scouting.org/Training/YouthProtection.aspx)
Is the adult leadership of your unit current in its VIRTUS Training? yes
AAD Candidates
PPXII Candidates
Adult Counselors
Additional Comments
Please note before pressing Submit:
Registration is not confirmed until payment is received.

Make checks payable to: Archdiocesan Catholic Committee on Scouting

Please mail payment to:
c/o Melvin Hart
8618 Sonneville
Houston, TX 77080
E-mail: hartmelvin@comcast.net
(713) 462-1464

(This address will display on the next page)

Also, please check everything in this page, including arithmetic

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Webmaster: Erich Wolz