Registration Form

ADM.43d
OLAVE BADEN-POWELL AWARD
REGISTRATION FORM
Please click the cursor inside the box and type or print clearly with a black pen
Complete to register an Olave Program participant as a candidate for the Olave Baden-Powell Award.
PERSONAL DETAILS
Preferred title: Given names: Surname:
Address:
Phone (BH): ( ) Mobile:
Phone (AH): ( ) Fax: ( )
Date of Birth: Membership no: Expiry Date:
State:
Postcode:
Email:
Date of Promise renewal:
Current position(s) in Guiding:
PEER GROUP DETAILS (if applicable)
Peer Group name:
District/Division/Region:
AWARD SUPPORT GROUP DETAILS
This is the Award Support Group you have chosen to help assess your progress. This group needs to know you well,
be your Guiding peers, have regular contact with you and be able to give a group recommendation to your State OB-
P Award Coordinator on completion of the Award. This group may consist of an Olave Program Peer Group or
Leaders in your District if you are working as a Leader.
Award Support Group members:
Award Support Group contact:
Address:
Phone (AH): ( ) Mobile:
State:
Postcode:
Email:
Date of approval of Plan of Action:
Signature of applicant:
Signature of Award Support Group contact:
1 of 2 May-2010

ADM.43d
OFFICE USE ONLY
Date received:
Acknowledgement sent:
Registration number:
Date of completion:
Date of Award presentation:
2 of 2 May-2010