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Membership Inquiry Form

If you are not already a Girl Scout and would like more information about the exciting opportunities in Girl Scouting, please complete the information below and a council representative will contact you soon. (Please note this is not a registration form. This information is only used to place you with the appropriate council representative.)
Parent or Guardian Name:
Phone:
Address:
City:
State:
Zip:
Email Address:
Daughter's Name:
Daughter's Age:
Daughters' Grade in School:
Daughter's School:
Are you interested in becoming a leader?	Yes No
Comments: