Registration Form for Adult Programs and Training

Use this form to register for courses for adults.  It can be submitted online or printed and mailed to Girl Scouts of Eastern Massachusetts, South Region, 111 East Grove Street, Middleboro, MA 02346.

Forms submitted online must contain credit card payment information for the entire amount. We do not hold places individuals who have not paid by the deadline, and we do not hold forms submitted online for checks to arrive in the mail.  If you wish to pay by check, please submit this form on paper with the check for the full amount.
 
Volunteer's Name: 
Mailing or street address
Town, state, zip
Day phone 
Evening phone
Email address
Are registered member of Girl Scouts? Yes  No
Troop number   (express as 5 digits, filling front with 0's:  00123 is Troop 123)
Troop level Daisy    Brownie    Junior    Teen
   
   
Adult program title
If there are workshops, choices for Morning Sessions:
If there are workshops, choices for Afternoon Sessions:
Program date
Location
Daughter's name, if attending
   
Payment method Visa    MasterCard    Check (with paper form only)    Debit Card
Account holder's name
Account number    (express as 0000 0000 0000 0000)
Expiration date   (if submitting paper form, write mo/yr here:  _______/_______ )
Security code   3 digits on the back of the card, near or in signature panel.
Total fees to be charged to card $  MUST BE FOR TOTAL AMOUNT
Notes or additional information:

  Please submit once.  There will be a pause of several seconds.

 
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