C.A.S.E. Training Workshops   

• Please print legibly and complete all sections.

• Use one form for each participant. You may photocopy this form.

Event Name: (please circle either)       Silver Award      Gold Award

Event Date: (please include a second or third choice)

    1st Choice ________________ 2nd Choice ________________ 3rd Choice ________________

Event Location: _________________________________________________________________

Participant’s Name: ______________________________________________________________

Address: ______________________________________________________________________

City/State: _______________________________________ Zip: ______________________

Phone: ( ) _________________________ E-mail Address: _______________________

Age: _______ Grade: ___________ Troop#: _____________

County:  DeKalb     Service Unit:  Three Leaves 

I am registering as a (please select) :  Cadette: _____________ Senior: ______________ Adult: _______________

To ensure our success in serving all girls, please circle your origin below.

American Indian	Asian	Black
Hispanic	Other	White

Mail To: Girl Scout Council of Northwest Georgia, Inc.

1577 Northeast Expressway

Atlanta, GA 30329

Attn: Tenequa Burrows

(6210-1-61-630 FOR OFFICE USE ONLY)