Troop Leadership Team member reserving the packaged program:

First Name
Last Name
Street Address
City
State
Zip Code
Day Phone
Eve Phone
Email

Troop Number: 

Troop Level:  Select one Daisy Brownie Junior Teen

Title of packaged program:  Select one All About Me Backyard Birding Bouncing Light Camp Tools Color Compass Cooking Creepy Crawlies Dive Into Diversity Doin' Good Five Senses Flurry Box Girl Scouts Around the World Girl Scouts in the USA Gross Out How Things Move Junior Master Gardener Knots Math Whiz Ocean Commotion Orienteering PAWS to Read Project Together Silly Screamin' Sports Stand up! Speak out! Starlight Stepping Out Teambuilding Theater Arts Theater Day for Large Groups Traveling Diversity Library When the Sun Goes Down Wizard's World Yes, I Can! Zink the Zebra

Date you would like to pick up the program:  -- mm/dd/yy

Date you would like to return the program:  -- mm/dd/yy

You may opt to pick up the package at the Service Center in Middleboro, or at your next Level Meeting.  Forms must be received at least 7 days before the meeting; orders received fewer than 7 days before a meeting will be brought to the next one.

Select location for pick-up:  Select one Service Center, Middleboro My next Level Meeting

If you selected the Level Meeting option, specify the date and location of the meeting (if nothing is specified, the reservation will not be made):

---------- YES, (YES must be selected here) I accept responsibility for the contents of this package and will return it on time, with the contents in good condition, or a service charge will be assessed.