Wihinipa Hinsa Lodge 113

Arrowmen, Scout Leaders, and Parents
Please provide the information below so that we can include you on our mailings:

First Name
Last Name
Address
City
State/Province
Zip Code
Home Phone	(include area code)
Work Phone	(include area code)
E-mail	Do not send me lodge news by email

Primary BSA Registration	Select One Cub Scout Pack Boy Scout Troop Varsity Team Venturing Crew Sea Scout Ship Explorer Post District      Number:
Leadership  Position	Select One Scout (youth) OA Representative Scoutmaster Varsity Coach Venture Crew Adviser Sea Scout Skipper Committee Chair Other Unit Leader Parent Non-OA member
District/Chapter	Select Chapter Coastal District - Do Pah Ke Sto Wa-we-ski Cradle of Texas District - Tendeuchen Langoma Thunderbird District - Mehokquiman Northern Star District - Woapossum

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If you are an Wihinipa Hinsa Lodge 113 member, please fill out the information below to help us keep our membership records current:

Date of Birth (m/d/y)
OA Honor	Select One Ordeal Brotherhood Vigil Candidate (non-member)
Ordeal Date
Brotherhood Date
Vigil Honor Date
Vigil Indian Name
Vigil Name Translation

Enter any comments or questions in the space provided below: