October 2021 Council of Chiefs

First Name: *

Last Name: *

Email: *

Date of Birth: *

Honor: * Ordeal Brotherhood Vigil

Lodge: * Akela Wahinapay Caddo Tejas Mikanakawa Netopalis Sipo Schipinachk Wichita Penateka Nakona Nischa Achowalogen Guest

What is your OA position? (select all that apply): Lodge Chief Lodge Officer Chapter Officer Lodge Member - Youth Conclave Vice Chief Section Officer Lodge Adviser Lodge Member - Adult CVC Adviser Section Adviser

Please provide any dietary restrictions:

Will you need housing on Friday night?: * Please select Yes No