Uh-Tō-Yeh-Hut-Tee Lodge OA Member Information Update


Complete the fields of these form that apply to you. You must give your name, email address, and your home phone number, in case we must contact you for clarification.

An asterisk * indicates a required field

* First Name     * Last Name: 
  Nick Name: 
  Address: 
  City, State Zip Code: 
* Home Phone (xxx-xxx-xxxx)     Cell Phone:      Work Phone: 
* E-mail Address     Add me to / keep me on lodge Email list:   Yes    No

  Adult/Youth (Check one)    Adult (21 or over)    Youth (under 21)   |  Male/Female (Check one):   Male    Female
  Birthday (mm-dd-yyyy): 

  BSA Registration Number:      Unit Number: 
  District/Chapter  

  If you are transferring or reactivating:
  Former Lodge:      Former Council: 
  Date of Ordeal (mm-dd-yyyy):      Brotherhood:      Vigil: 

Send Your Information         Please click one time only
Please check that you have entered all required fields correctly!!
Fields in Red need attention!!