Girl Scouts Of Central Indiana Council Event Registration Form
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1Girl Scouts of Central Indiana
Registration Information
Council Event Registration Form
Mail council registration form and payment to:
GSCI, Attn. Program Registration, 2611 Waterfront
Parkway East Drive, Indianapolis, IN 46214 –OR-
Fax council registration form with credit card number
Please use one registration form for each event. This form may
to 317.931.3346
be copied or saved to your computer and e-mailed. Please print
Each troop is responsible for providing only enough
clearly and complete all sections. If you have a multi-age level
adults to meet Safety-Wise ratios. Those registering
troop, girls need to attend the age-level appropriate to the
individually should also be accompanied by an adult.
event (i.e. Girl Scout Brownies cannot attend events for Girl
Only registered Girl Scouts may participate in council
activities.
Scout Juniors even if they are in the same troop).
Troop #
Age level
Location/session
Event title
Event date
Event time
Please print the name(s) of those attending this event. Use an additional sheet of paper if necessary.
Name
Grade
Name
Grade
Girl
Adult
Girl
Adult
Girl
Adult
Girl
Adult
Girl
Adult
Girl
Adult
Girl
Adult
Girl
Adult
Girl
Adult
Girl
Adult
Total #
Individual cost
Total
In order for your registration to be processed it
Girls
$
$
must be accompanied by payment in full
Adults
$
$
unless otherwise indicated.
Total due:
$
Select payment type (please check one)
Cash
Check
Credit Card
cookie dough
If paying by credit card, card holder’s name: ___________________________________________________
Card type _____________ Card no. __________________________________ Exp. date ________________
Leader’s name _____________________________________________________________________________
Home mailing address _____________________________________________ City Zip__________________
Email address ______________________________________________________________________________
Day phone ( ____) __________ Cell phone (____ ) _______________ Eve. phone (____ ) _______________
Please select how you would like to receive your bill (please check one)
USPS mail
E-mail
Agreement of understanding
I understand that if we are selected for this event, I am financially responsible for the above number
of girls/adults and will owe the event balance amount unless I have cancelled in writing 15 calendar
days prior to the program event.
Name (please print) _________________________________________________________________________
Signature ____________________________________________ Date _________________________________
For internal use only
Received _______________ Receipted _______________ Entered ____________ Event code ________________
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