INDIVIDUAL REGISTRATION INFORMATION

Last Name

First

M.I.

Date

Street Address

Grade in School

  Select One 04 05 06 07 08 09 10 11 12

City

State

ZIP

Phone

E-mail Address

Registered Girl Scout?

YES   NO

Troop Number:

Service Unit:

Troop Leader Name

T-Shirt Size:

Select One YL AS AM AL AXL A1X

PARENTAL OR GUARDIAN CONTACT

Please provide at least one contact.

Full Name

Relationship

Email Address

Phone

Full Name

Relationship

Email Address

Phone

EVENT COST

Make checks out to TROOP 790. Please select only one option.

Registered Girl Scout

$10

Non Registered Girl Scout

$11

NOTE: The extra $1 for non-registered Girl Scouts is to cover insurance for the event.