Welcome to Registration!
Fields with a " * " are required to be filled out.

Personal Information

*Birthday (xx/xx/xxxx)
*Mailing Address


*State (xx)

*Zip Code
*Phone xxx-xxx-xxxx

*Email Address
Did you attend Conclave in 2003 or 2004?
  Do you currently hold an OA office/position?
  ..if so, what title?
  Attaining Brotherhood at Conclave?
  Reference to Conclave?


Health / Consent Information

  *In case of an emergency contact:

*Phone 1:

Phone 2:

Health Insurance Company

Policy Number (optional)

Check all that apply:


Asthma :

Food Allergy
  Diabetes : Plant Allergy
  Heart Conditions : Animal Allergy
  Attention Defecit : Insect Allergy
  Depression : Toxin Allergy
  Bedwetting : Medication Allergy
  Fainting Spells :    

Any conditions that require care:

Special Medication:

Special Diet:

Explanation of any health concerns above:
List of current medication(s) and dosage(s):

Physical Limitations:
Tetanus Month:

Tetanus Year:




In case of an emergency, I understand every effort will be made to contact me (if an adult, my spouse or next in kin.) In the event I cannot be reached, I herby give my permission to the physician selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child/myself.

*Adult Consenting:



Membership Information



*OA Honor




Lodge Not Listed


*Ordeal Month


*Ordeal Year


Number of Conclaves Attended:


Training Information


  If you attended Conclave 2003 or 2004 and earned an associates degree from Machquigen University you qualify for a bachelor’s degree.  If you attended Conclave in 2004 and earned a bachelors degree from Machquigen University you quality for a master's degree. If you forgot your college and wish to continue forward you may view the list of sessions you took last year at the following link.
  College Major:

CIA: College of Indian Affairs
CLP: College of Leadership and Program
CNA: College of New Arrowmen
COA: College of Outdoor Adventure
CGS: College of General Studies
COP: College of Professorship (Must be pre-approved)


Click Here for a Description of the Courses

Session 1:

  Session 2:
  Session 3:
  Session 4:


By submitting your registration information, you indicate that you agree to the
Terms and Conditions and have read and understand the Code of Conduct. Your submission of this form will constitute your consent to the collection and use of your personal information and the transfer of this information to the Conference Management and or other adult officials for processing. All information provided by means of your online registration will remain private and privileged to only adult advisors affiliated with the Section Council of Chiefs. Lastly by submitting your registration information you agree to receive required administrative and promotional information electronically.

Click Submit to go to the Confirmation Page
If you experience problems with the submission, please contact Brandin Grams

Section W-4B Officers

Michael Gollner
Section Chief

Josh Insalaco
Section Vice-Chief

Brandon Guzik
Section Secretary

Section W-4B Advisers

Dennis Underwood
Section Adviser

Deanna Westmyer
Associate Adviser

Scott Oldenburg
Staff Adviser

Copyright 1996-2004 Machquigen Section W-4B, Western Region, Order of the Arrow, BSA