Program Event Registration Form

Please fill out entire form.

This is a secure form. If you do not wish to submit online, you may print out this form, fill it out and send it directly to

Girl Scouts of the Sierra Nevada, Attn: Program

FAX: (775) 322-0701 or

MAIL: 605 Washington Street, Reno, Nevada 89503.


Individual Registration
Girl's Full Name:
Troop Number:
Service Unit:
Program Level:
Address:
City:
State:
Zip Code:
Phone:
Email Address:
Please check all that applies:	Yes, I would like an email confirmation. Yes, I would like to be a helping hand.
Troop Registration
Troop Number:
Service Unit:
Program Level:
Troop Leader's Full Name:
Mailing Address:
City:
State:
Zip Code:
Phone:
Email Address:
Please check all that applies:	Yes, I would like an email confirmation. Yes, I would like to be a helping hand.
Program Event Information
Name of Event: *
Location: *
Date: *
Time: *
Number of Girls attending: *
Total Cost (Girls): *
Number of Adults attending: *
Total Cost (Adults): *
Total Participants: *
Total Cost (All): *
Financial Assistance Applied For:
Cookie Credit Applied For:
Total Paid: *
Online Payment
Credit Card *
Card Holder Full Name: *
Credit Card Number: *
Card Expiration Date: *
Securtity Code: *
Card Billing Zip Code: *