* = Required Field(s) |
*Name: |
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| *Address: |
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| *City: |
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| *State: |
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| *Zip: |
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| *Phone: |
() |
| Best time to reach you? |
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| *E-mail: |
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| Present Occupation: |
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| Have you ever been a Girl Scout? |
Yes No |
| Briefly Desribe: |
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| How often are you available to volunteer? |
Once a week Once a month Occasional |
| When are you most likely to be available? |
Daytime Evening Weekend Flexible |
| Do you have a girl who is a Girl Scout? |
Yes No |
If your girl wants to join Girl Scouts, have you contacted us previously? |
Yes No |
If no previous contact, please list her full name and your relationship to her: |
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| How would you like to be involved with Girl Scouting (select all that apply)? |
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| If you are inquiring about becoming a Girl Scout Leader, what age level are you interested in? |
| Daisy Brownie Junior 11-13 13-15 15-17 |
| Do you have any comments or questions? |
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