2019 MOHAB Registration FormStep 2: Complete the MOHAB Registration Form Use this form to submit a registration request for your troop, crew, or provisional Scout for a MOHAB program. We'll call you back to confirm your registration and help you process your payment!Are you a:* Boy Scout Troop Varsity Team Venture Crew Provisional Scout or Scouts OtherInformation About Your Troop/Team/Crew/Provisional GroupTroop/Team/Crew #*District*Council*# of youth (14-20 years old) you expect to bring:*# of adults (21+ years old) you expect to bring:*How many High Adventure Crews would you like to form at MOHAB (maximum Wilderness crew size is 13)*12Unit Trip Coordinator (or Provisional Scout Parent/Primary Adult Contact)Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Alternate Unit / Adult ContactName* First Last Phone*Email* Select the Trek & Dates for this ApplicationWhich MOHAB Treks are you interested in (check all that apply)?* SESSION 1 (June 23-30, 2019) - Wilderness Trekking I SESSION 1 (June 23-30, 2019) - Wilderness Packrafting I SESSION 1B (June 23-July 7, 2019) - Wilderness Trekking II (50 Miler Program - 2 Weeks) SESSION 1C (June 23-July 7, 2019) - Wilderness Packrafting II (MOHAB EXTREME - 2 weeks) SESSION 2 (June 30- July 7, 2019) - Wilderness Trekking I SESSION 2 (June 30 - July 7, 2019) - Wilderness Packrafting I SESSION 3 (July 7-14, 2019) - Wilderness Trekking I SESSION 3 (July 7-14, 2019) - Wilderness Packrafting I SESSION 2B (July 7-21, 2019) - Wilderness Trekking II (50 Miler Program - 2 Weeks) SESSION 2C (July 7-21, 2019) - Wilderness Packrafting II (MOHAB EXTREME - 2 weeks) SESSION 4 (July 14-21, 2019) - Wilderness Trekking I SESSION 4 (July 14-21, 2019) - Wilderness Packrafting I
