Eagle Scout® PROJECT MARKER PLAQUE - Scoutstuff.org

■ Honor your new
Eagle Scout
A new tradition in keeping with
Scouting's most distinctive award.
■ Immortalize their project
■ Highlight community
achievements
■ Promote the BSA legacy
in a unique, visible way
Personalized EAGLE SCOUT ®
PROJECT MARKER PLAQUE in etched
black marble is an impressive way to
honor this life-defining award, 8''x10''.
With each plaque purchased, the recipient
receives a FREE INITIAL MEMBERSHIP
in the National Eagle Scout Association
(NESA)!
SKU# 617492 $ 199 99
Order form available at www.scoutstuff.org

ORDER FORM
Eagle Scout ®
PROJECT MARKER PLAQUE
617492 - $ 199 99
Please complete the following information:
Date____________________________ Your Order No._______________________
SOLD TO___________________________________________________________
Address____________________________________________________________
City________________________________________ State______ ZIP__________
Telephone__________________________________________________________
SHIP TO____________________________________________________________
Address____________________________________________________________
City________________________________________ State______ ZIP__________
Telephone__________________________________________________________
EAGLE SCOUT’S NAME _____________________________________________________________________________________________________________________
Date of Birth __________
Month
_________ _________
Date
Year
Type of Unit ______________________________________________________________________ Unit No. ________________________________________________
(Troop, Crew, Ship, etc.)
City/State_______________________________________________________________________________________________________________________________
Project Completion Date ___________________________________________________ Board of Review Date ________________________________________________
Project Description ________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
Project Location Description__________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
Location City/State ________________________________________________________________________________________________________________________
Location GPS Coordinates___________________________________________________________________________________________________________________
(Sample: 37.91°N 81.11°W)
*Applicable links to a project website or videos (if they exist)__________________________________________________________________________________________
*Due to the characteristics of the material, each piece may appear slightly different. Allow up to 4 weeks for delivery.
Please fax or mail to: P.O. Box 7143 • Charlotte, NC 28241-7143 • Fax: 704-588-5822
INTERNAL USE ONLY:
Confirmation of transfer to NESA_______________________________________________________________________________________________________________
_____________________________________________________________________________________________
Signature
______________________________________
Date