Event Registration Form

  • Use this form for all Cadette and Senior Programs
    (Program Aide, LIT, Wider Ops, Chaperone Training, Etc.)

  • Please print legibly and complete all sections.

  • Use one form for each event. You may photocopy this form.

 

Event Name: _________________________________________________________________

Event Date: 1st Choice ________________ 2nd Choice ________________ 3rd Choice ________________

Event Location: _________________________________________________________________

Participant’s Name: ______________________________________________________________

Address: ______________________________________________________________________

City/State: _______________________________________ Zip: ______________________

Phone: ( ) _________________________ E-mail Address: _______________________

Age: _______ Grade: ___________ Troop#: _____________

County:  DeKalb     Service Unit:  Three Leaves 

I am registering as a (please select) :  Cadette: _____________ Senior: ______________ Adult: _______________

 

To ensure our success in serving all girls, please circle your origin below.

American Indian

Asian

Black

Hispanic

Other

White

Financial Aid Requested: Yes: ______ No: ______ Amount Requested: ______________

Type of Payment: Cash Amount: _____________ Money Order Amount: ___________

Check Amount: ____________ Cookie Credit Amount: ___________

Amount of Financial Assistance Requested: ____________________________________________

Total Amount of Event: ___________________________________________________________

 

Mail To: Girl Scout Council of Northwest Georgia, Inc.

1577 Northeast Expressway

Atlanta, GA 30329

Attn: Tenequa Burrows

 

(6210-1-61-630 FOR OFFICE USE ONLY)