SENECA WATERWAYS COUNCIL - ORDER OF THE ARROW DUES FORM
	Please print out, complete and return with payment by February 26, 2010 to: Seneca Waterways Council 474 East Avenue Rochester NY 14607
	Name:_______________________________________	Unit: _______________________________
	Address:_____________________________________	District: ____________________________
	City/Zip: _____________________________________	Date of Birth: ________________________
	Daytime phone: _______________________________
	E-mail address: _______________________________
	Ordeal date*: _________________________________
	Brotherhood date*: ____________________________
	Vigil date*: ___________________________________
	* approximate if unknown, ex: Spring 1994, Summer Camp 2003, Fall 2009
	Reminder: in order to continue your membership in the Order of the Arrow and wear the insignia of the Lodge, you must be currently registered in Seneca Waterways Council and be BSA dues current. You will need to return the Dues form plus the OA Participation and Medical Information Consent form in order to be registered in the Lodge for 2010. Checks shoud be made payable to "Seneca Waterways Council."
	Dues Payment Options
	_____ I am enclosing $11.00 annual Lodge dues for the following years:
	_____ 2010 _____2011 _____ 2012
	OR
	_____ I would like to be a Century Clan* member at $100.00 per year for the following years:
	_____ 2010 _____2011 _____ 2012
	For credit card payment, please complete the following:
	_____VISA _____MASTERCARD _____DISCOVER _____AMERICAN EXPRESS
	Card Number: _________________________________	Exp Date: _____________________
	Name on card: ________________________________	CVV No: ___________ (3 digit number on back of card)
	Cardholder Signature: ______________________________________________