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Chapter and Lodge E-mail Request

Please complete the following form.
All fields marked with ^* are required.
An e-mail will be sent to the youth selected and his adviser.

^*Contact:
^*Your Name:
^*Your E-mail:
Your Phone #:
Your Mailing Address
^*Contact Method
^*Subject:
^*Message:
Message Priority:

District	Chapter
Black Mountain	Wulinaxin
Desert Trails	Elauwit
Heartland	Hadaazli-to
Kit Carson	Kah-shinni
Mission	Shash-tsoh
Pacific Coast (North)	Bitani
Pacific Coast (South)	Naabaahii
Pacific Crest	Pischk
Santa Margarita	Bitani
Scripps Mesa	Wulinaxin
Sweetwater	Allohak
Tecolote	Naabaahii

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