Pack 1232 - Selkirk Volunteer Fire Company No 2 201868675 APPLICATION DETAILS Application ID 201868675 Parent / Guardian MemberID ID 141702154 Applicant Member ID 141702163 Applied to Organization Twin Rivers Council 364, Fort Orange 01, Pack 1232, Selkirk Volunteer Fire Company No 2 Submitted Date 08/21/2025 00:00:00 Current Status Completed Current Status Date 08/20/2025 20:43:57 BSA Youth Registration (Trad.) $85.00 Scout Life Domestic Rates $15.00 Council Fee $57.00 Administrative Fee OLR $2.75 1 STEP 1: YOUTH INFORMATION First Name William Last Name Susser Age 8.5y Gender Male Grade Fourth Grade Ethnic Background Caucasian/White Country USA Address Line 1 16 Woodmont Dr Address Line 2 City Delmar State NY Zip Code 12054 Personal and Confidential for Authorized BSA Use Only Page 1 YOUTH APPLICATION

Pack 1232 - Selkirk Volunteer Fire Company No 2 201868675 2 STEP 2: PARENT INFORMATION First Name Megan Middle Name Last Name Susser Age 40.5y Gender Female Ethnicity Caucasian/White Relationship to youth Son of Country USA Address Line 1 16 Woodmont Dr Address Line 2 Address Line 3 City Delmar State NY Zip 12054-3810 Phone Number 001 (518) 569-7320 Email Address allsmiles12@gmail.com Personal and Confidential for Authorized BSA Use Only Page 2 YOUTH APPLICATION

Pack 1232 - Selkirk Volunteer Fire Company No 2 201868675 2 STEP 3: ADULT PARTNER INFORMATION First Name Middle Name Last Name Age y Gender Ethnicity Relationship to youth Country Address Line 1 Address Line 2 Address Line 3 City State Zip Phone Number Email Address Personal and Confidential for Authorized BSA Use Only Page 3 YOUTH APPLICATION

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Original PDF: William Susser Application.pdf