Staff Annual Registration Form - B

This page must be submitted with complete Annual Application to the Dakota Youth Ministries Department to receive your certification.


The individuals listed below are presently working as officers and staff of our club and desire to be registered with the Dakota Conference for the current year.


Individual #1:


Individual #2:


Individual #3:


Individual #4:


Individual #5:


Individual #6:


Individual #7:


Individual #8:


Individual #9:


Individual #10: