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Connect with GSGCNWI

Please complete the following interest indicator so we may better understand how to contact you and how you would like to reconnect to the Girl Scouts.

* Required

Title

First Name *

Last Name *

Email Address *

Company *

Date of Birth *

Home Address *

City *

State *

Zipcode/Postcode *

Country *

Work Address *

City *

State *

Zipcode/Postcode *

Country *

Home Phone Number *

Work Phone Number *

Employer

Daytime Phone

Evening Phone

Preferred Method of Contact *
Daytime phone
Evening phone
Email
US Mail

Yes, I was a girl member. Please add city and decade.

Yes, I am an adult member of Girl Scouting. Please enter number of years in service.

Other current involvement

Other former positions

Home Address Line 2

Work Address Line 2

Adult Involvement
Leader
Parent of a Girl Scout
Girl Scout Volunteer

Girl Involvement
Girl Scout Daisy (grades K-1)
Girl Scout Brownie (grades 2-3)
Girl Scout Junior (grades 4-5)
Girl Scout Cadettes (grades 6-8)
Girl Scout Senior (grades 9-10)
Girl Scout Ambassador (grades 11-12)
Gold Award Recipient
Attended Girl Scout Camp

Location(s) of Involvement

Comments or any other information you would like to share

Lifetime Member since

My favorite Girl Scout memory:

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