Promotional Material Order Form

Portola District
Atwood, Brea, Placentia, Yorba Linda

Today's Date:    
Due Date:    
Time Needed:
Order For: Pack Troop Team Crew  
Unit Number:
Recruitment Day of the Week: Monday Tuesday Wednesday Thursday Friday Saturday Sunday     
Recruitment Date:    
Recruitment Time:
Recruitment School(s) or Location:
Contact Name:
Contact Phone Number:
Contact E-Mail:
Any Special Instructions:
Quantity of Flyers:
Quantity of Stickers:

Name, phone number and e-mail of person filling out this form, if different than contact information above:
Name: Phone: E-mail:

Enter the code as it is shown (required):