Troop/group Event Registration Form
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24806 Seton Drive
Baltimore, MD 21215
T 410.358.9711
F 410.358.9918
Troop/Group Event Registration
Please print clearly or type, mail or fax
Event date: ___________________________________ Time: ____________
May 29, 2015-May 30, 2015
5:30pm-7am
Location: ______________________________________
Baysox Stadium. 4101 Crain Highway
Bowie Baysox Girl Scout Sleepover
Code & Event name: _________________________________________________________________________________________________
First name: __________________________________________ Last name: ___________________________________________________
Troop#:______________ Service Unit: _________ Email: _________________________________________________________________
Street address: _____________________________________________________________________________________________________
City: _______________________________________________________________ State: _____________
Zip: ___________________
Home phone: ____________________________________________ Cell phone: ________________________________________________
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#Girls:___________________x fee: $__________________=Total due: $ ________________________ Amount enclosed: $___________
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#Adults:_________________ x fee: $__________________=Total due: $ ________________________ Amount enclosed: $___________
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#Non-members:__________ x fee: $_________________=Total due: $ _________________________Amount enclosed: $___________
Grand total due: $ ______________ Total enclosed $ ___________
Indicate payment type: Check
Visa
Master Card
Check details:
Name on check: _____________________________________________________Check #:______________
Credit card information:
Card #:____________________________________
Exp. Date: _____________
Security Code___________________
(Security Code is the 3 digit code on the back of the credit card)
Cardholder (Print Name):_________________________________________________
Address: ______________________________________________________________
City: ____________________________
State:_____________________
Zip:_______________
Home Phone: _____________________________
Work:_____________________________________
Cardholder Signature: _________________________________________________________________
Does anyone in your Troop have any special need such as physical or learning disabilities, dietary, etc.? Please explain:
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Please indicate the number of participants in each grade:
K: ___ 1: ___ 2: ___ 3: ___ 4: ___ 5: ___ 6: ___ 7: ___ 8: ___ 9: ___ 10: ___ 11: ___ 12: ___
Please indicate the number of participants of each racial/ethnic origin:
African American: ____ Asian: _____ Caucasian: _____ Hispanic: ____ Native American: ____
Indian or Alaskan Native: ___________
Native Hawaiian or Other Pacific Islander: _____
More than one race: ________________
04-3120
05/12
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