Event Name: _________________________________________________________________

Event Date: _________________________________________________________________

Your Name: ______________________________________________________________

Address: ______________________________________________________________________

City/State: _______________________________________ Zip: ______________________

Phone: _________________________ E-mail Address: ____________________________

Age: ______ Grade: ______      (  ) Cadette   (  ) Senior    Troop#: _____________

County: _____________    Service Unit: _____________

Financial Aid Requested: Yes: ______ No: ______ Amount Requested: ______________

DO NOT SEND MONEY WITH THIS FORM - YOU WILL BE BILLED LATER

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

American Indian	Asian-American	African-American
Hispanic-American	European-American	Other ________________

Mail To:	Laurel Martin
	Girl Scout Council of Northwest Georgia, Inc.
	1577 Northeast Expressway
	Atlanta, GA 30329