Girl Scouts of River Bluffs Council • #4 Ginger Creek Parkway • Glen Carbon, IL 62034
(618) 692-0692 - (800) 345-6858 - FAX (618) 692-0685 • gsrbc@riverbluffs.org
Print page, complete and mail/fax (fax only with credit card info) with fee.
Program Registration Form For Troops
FINANCIAL ASSISTANCE IS NOT AVAILABLE FOR TROOP EVENTS!
Name of Event _________________________________________________Event # _______
Date of Event ______________________________Time of Event ______________________
If choice of sessions, list: 1
st ________________ 2nd_______________ 3rd ______________Leader/Advisor Name_________________________________________________________
Troop/Group # _____Service Unit # _____Troop Program Level________________________
Address __________________________________________________________________
City _____________________________________________ST_____ Zip Code _________
Phone # (D) __________________________________ (E) __________________________
E-Mail ___________________________________________________________________
Additional Information ________________________________________________________
_________________________________________________________________________
Fees:
1. Total # of girls ______ X cost $____________ = $_______________
2. Total # of adults ______ X cost $____________ = $_______________
TOTAL $_______________
Payment:
1 Check enclosed: # ___________ Amount $__________ 1 Mastercard 1 Visa 1 DiscoverCard Number ____________________________________Expiration Date _____________
Amount $___________Signature ______________________________________________
Use this area to list names of girls and adults if requested:
8/27/07