EmailMe Form - Coin Collecting Merit Badge Course Registration

Scout Name *

First Last

Scout Email *

This is the email that will receive information to access the online course.

Troop Number *

Scout Age *

ANA Member Number

Membership is NOT required.

How did you hear about this? *

Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Parent/Guardian Name *

First Last

Parent/Guardian Email *

Parental/Guardian Consent

By clicking below, I, as the parent or legal guardian of the above-named child, give consent for my child’s information to be collected and used solely for the purpose of registering and coordinating their participation in the Youth Coin Class. I understand this information will be securely stored and not shared with third parties. I also confirm that I am 18 years of age or older and authorized to provide this consent. *

Agree