Professional Documents
Culture Documents
PLEASE PRINT
Name of Event/Training:
Cost: $
per person, amount enclosed $ Full payment must accompany all registrations
VISA/MasterCard/Discover Cardholders Signature Girl/Adult Name Complete Address Email Home Phone ( Troop Leader Troop # Age level: Daisy Brownie Junior )
Expiration Date
Work (
) Service Unit
Cadette
Senior
)
Adult
If parent is not available, second emergency contact (cannot be pager #) Name Phone (
1377 W. Shaw Ave., Fresno, CA 93711 1831 Brundage Lane, Bakersfield, CA 93304 (800) 490-8653 FAX (559) 291-5079
OFFICE USE ONLY Date received
Initials
Amount received