REMEMBRANCE AREA INFORMATIONAL QUESTIONnAIRE

To be considered for the Remembrance Area, an individual could have been a young person, adult leader, Ma-Ka-Ja-Wan staff member, a member of the Order of the Arrow, a member of the Wilderness Engineering Society, a Professional Scouter, or a local Pickerel/Pearson volunteer. The individual considered shall be deceased. Each name to be considered will be reviewed each year and verified before they are added to the Remembrance Area. Questionnaires must be submitted by March 1 to be considered for the current year.

Name of Nominee

First Name

Last Name

Date of Passing (can be approximate)

YYYY

Place of Residence (at time of passing)

Unit Affiliations (types and numbers, positions held, years active)

Order of the Arrow (honors and years active)

Camp Staff (years and positions)

Wilderness Engineering Society Involvement

District or Council Positions

Other Awards or Recognition

Other Affiliations with MSR, Other Pertinent Information

Community Involvement (service clubs, churches, etc)

Military Service (branch, conflicts, honors, years of service)

Submitted by

First Name

Last Name

Contact Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Person (leave blank if different from above, preferably a family member of the nominee)

First Name

Last Name

Contact Person Email

Contact Phone

(###)

###

####

REMEMBRANCE AREA INFORMATIONAL QUESTIONnAIRE

Ma-Ka-Ja-Wan Scout Reservation

Northeast Illinois Council