Girl Scouts Of Northeast Texas Girl Registration Form
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1Girl Scouts of Northeast Texas
GIRL REGISTRATION -
Council Code 597
Membership Year 20
- 20
Return with $15 annual membership dues to the troop leader.
Troop #
SU #
.......................
................
Check one:
New
Reregistering
..... please write on dotted line .....
What is the Girl Scouts of
.......................................................................................................................................................................................................................................
Northeast Texas
Girl’s Name: First
Middle
Last
Family Partnership
.......................................................................................................................................................................................................................................
Campaign?
Mailing Address / Apartment #
.......................................................................................................................................................................................................................................
The GSNETX Family Partnership
City
State
Zip Code
County
Campaign is a way for Girl Scout
families to invest in girls’ futures
.............................................................................
......................................................................................................................................................
by providing the financial support
Phone Number
Email (parent/guardian)
needed to support all of the things
...................................................
......................
.............................................................................................................
...............................
your daughter loves about Girl Scouts.
Date of Birth
Grade
School Name
#of completed years
Annual fees go directly to GSUSA,
as a Girl Scout
however money raised through Family
She is under the custodial care of:
Both Parents
Mother/Guardian only
Father/Guardian only
Other
.........................
Partnership stays here at Girl Scouts
By entering your email address above, you give GSNETX permission to send council news to the address listed.
of Northeast Texas! That means 100
GSNETX will not share, sell distribute or rent your information to anyone.
percent of Family Partnership money
goes towards the camps she loves,
to the volunteers who support her,
and the programs she’ll talk about
......................................................................................................................................................................................................................................
Primary Parent/Guardian: First
Middle
Last
all year! Your donations help make
it all possible, participate in Family
......................................................................................................................................................................................................................................
Partnership today!
Address (if different than girl’s)
City
Zip Code
County
What Your Gift Can Do!
......................................................................................................................................................................................................................................
$50 - Sends a Girl Scout Troop Leader
Employer
Email
to a CPR or First Aid Certification
......................................................................................................................................................................................................................................
Class.
Phone Number (home)
(work)
(cell)
$75 - Helps girls experience water
safety by providing 3 life vests.
$100 - Feeds 9 horses in Camp
......................................................................................................................................................................................................................................
Parent/Guardian: First
Middle
Last
Bette Perot’s Equestrian Program for
one week.
......................................................................................................................................................................................................................................
$250 - Sends a girl to camp for one
Address (if different than girl’s)
City
Zip Code
County
week.
$500 - Provides membership to 40
......................................................................................................................................................................................................................................
girls in an elementary Girl Scout troop
Employer
Email
in an underserved community.
$1,000 - Provides a Girl Scout Gold
......................................................................................................................................................................................................................................
Award recipient a scholarship to the
Phone Number (home)
(work)
(cell)
college of her choice and you will be
recognized in the Second Century
We encourage you to provide the following information to help Girl Scouts improve our outreach efforts to reach every girl, everywhere.
Circle.
1. My racial background is: (check one)
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or Pacific Islander
White
Other
2. My ethnic background is: (check one)
Hispanic or Latina
Not Hispanic or Latina
I confirm that the registrant will abide by the Girl Scout Promise and accept the Girl Scout Law. The registrant has my permission to join Girl
Scouts. I understand that when participating in Girl Scout activities the registrant may be photographed for print, video or electronic imaging. I
understand the images may be used in promotional material, news releases, and other formats for either Girl Scouts of Northeast Texas or Girl
Girl Scouts of Northeast Texas
Scouts of the USA. I acknowledge that the images will be the sole property of Girl Scouts of Northeast Texas or Girl Scouts of the USA.
972-349-2400
Signature .....................................................................................................
Date ....................................
(Membership dues are not refundable or transferable to another person)
Membership
15
Cash
$__________
Check #
__________
Financial Assistance Requested
GSUSA Membership Dues $___________
(payable to Girl Scouts of Northeast Texas)
Credit Card #
__________________________________________________________________
CVV#:
______________
Billing Zip Code:
_____________
Name on Credit Card_____________________________________________Exp
Date_____________
VISA
MasterCard
........................................................................................................
......................................
Signature______________________________________________________Date________________
Discover
Am. Express
Family Partnership ~ I want to support the Girl Scout Leadership Experience with a gift of:
$1,000
$500
$100
$50
$35
Other
$_________
TOTAL TO CHARGE CREDIT CARD: (Membership and Family Partnership)
$_______________
Charge Credit Card # above
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