Event Registration Form - Girl Scouts Of The Missouri Heartland Page 2
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1
2Participants/Attendees
NOTE: Events are designed for specific numbers and ages of participants.
Registered
Payment Method(s)
Gender
First & Last Names of Children
Grade
Age
City
Girl Scout?
Fin.
Cookie
Cash/
(M/F)
(under age 18)
+
Asst.*
Check
Credit
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
Names of Adults
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
TOTAL
$
$
$
*Financial Assistance is only available to registered Girl Scout members.
+
Girl Scout Cookie Credit may only be used to pay for the Girl Scout who earned it.
___________________
Please share if any person(s) in troop/group has special needs (e.g., allergies):
____________________________________________________________________________________
____________________________________________________________________________________
This form, and any applicable event fees, must be received by the registration deadline. To ensure that
your registration is only processed and charged once, please use only one of the following submission
methods:
Fax to 417-862-4120 (must include credit card number for payment)
Email to
(must include credit card number for payment)
Mail to a GSMH service center
Walk in to a GSMH service center
For updated service center mailing addresses and hours, please visit
Girl Scouts of the Missouri Heartland, Inc.
T 877-312-4764 ● F 417-862-4120 ● ●
(Page 2 of 2)
P:\Forms\Public\External\Event Registration\Event Registration 310114
P:\GSMOHEARTLAND DATA\Forms\Event Registration 6-10-13
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