Girl Scouts of the Missouri Heartland, Inc.
Training Registration Form
Please bring this completed form, along with the registration fee, to your local service center. Or, you
may mail form and payment to Girl Scouts of the Missouri Heartland, Attn: Training Registration.
NOTE: Adult Training Registration Form must be received at least 14 days prior to training.
Personal Information
Name ____________________________________ Troop #____________ Service Unit # __________
Address ___________________________________________________________________________
City _____________________ County _____________________ State _______ Zip ______________
Home Phone _________________ Work Phone _________________ Cell Phone ________________
Email _____________________________________________________________________________
(Confirmation will be sent to provided email addresses.)
Age Level Currently Serving
□ Daisy
□ Brownie
□ Junior
□ Cadette
□ Senior
□ Ambassador
(K-1st)
(2nd-3rd)
(4th-5th)
(6th-8th)
(9th-10th)
(11th-12th)
Training Information (You may register for up to two trainings at a time.)
Name of Training
Location
Date
Time
1.
2.
Payment Information
Training fees must be paid at time of registration. Please make check payable to: GSMH.
Check(s), made payable to Girl Scouts of the Missouri Heartland, Inc.
$_______
Financial Assistance Request for Volunteer Training
$_______
(Financial assistance form must be attached for each person requesting it.)
Credit Card
$_______
(Please complete information below.)
TOTAL ENCLOSED
$_______
Credit Card Type: ___________________
Card #: _____________________________ Expiration Date:________
Name on Card: _______________________Signature: ________________________________
This form, and any applicable fees, must be received by the registration deadline. Forms may be faxed,
emailed, mailed, or walked in to any Girl Scout service center. For updated service center mailing
addresses and hours, please visit Faxed and emailed forms must
include a credit card number for payment.
Confirmations and refunds: Confirmations will be sent after the training meets minimum required
number of participants. Cancellations are to be made prior to registration deadline date. No refunds will
be given after the registration deadline date unless the training is cancelled by the council. All refunds
of $5 or less will be in the form of a credit to GSMH Retail Shops.
Girl Scouts of the Missouri Heartland, Inc.
877-312-4764 ● ●
P:/GSMOHEARTLAND DATA/Forms/Volunteer Forms/ 6-11-13