Girl Scouts of Tanasi Council_ Inc

							                          The Event Registration Form
                                    Girl Scout Council of Southern Appalachians


Copy this form as needed to register individual girls, troops and/or adults for any Girl Scout activity. Please complete both
sides and use one registration form for each event. Confirmations will be emailed/mailed one week prior to the event. If you
have any questions about your registration please call the Program Registrar at 1-800-474-1912.



Event Name                                  Event Date                             Location

Leader/Adult Name                                                        Troop #              Service Unit

Address                                                         City, State                                   Zip

Home Phone                               Cell Phone                                 Work Phone

Email Address


Is troop                      No



                                                                      PRICE/
                              NUMBER                                                                         TOTAL
                                                                     PERSON
                  GIRLS                               X                                        =        $
              ADULTS                                  X                                        =        $
                                                            TOTAL AMOUNT DUE                   =        $



PAYMENT INFORMATION:

I have enclosed

$            Cash     $            Check    $                Cookie Dough     $               Credit Card (Please complete below)

Please Select One:        Visa          MasterCard            Discover

Card Number:                                          ___           Expiration Date: ________________ 3 Digit Code _____________

Print Name as on Card:             __                          Credit Card Signature: __________________________________________



*Refund Policy: You must inform the program registrar of your cancellation by the registration deadline to receive a full
refund.
PARTICIPANT INFORMATION (Please list all participants, including adults):



                                               NAME                                        GIRL GRADE          ADULT

            1.
            2.
            3.
            4.
            5.
            6.
            7.
            8.
            9.
            10.
            11.
            12.
            13.
            14.
            15.


Any food/dietary restrictions or any other consideratations? _____________________________________________________________________
________________________________________________________________________________________________________________________________________



I have read the Safety Activity Check Points and understand the girl to adult ratio needed to attend this event. I also understand
this event may be cancelled if the minimum number of registrants needed is not met.


Signature                                                                              Date



PLEASE SEND REGISTRATION WITH COMPLETE PAYMENT TO:


Girl Scout Council of Southern Appalachians
ATTN: Program Registration
1567 Downtown West Blvd.
Knoxville, TN 37919