Girls Empowered Troop/Scout Workshop Request Form

Workshop Requested:
Date of Workshop:	1st choice,  2nd choice,
Time of Workshop:	(start time after snack!)
Location:	(Name of school or other)
Address of School:
City of School:
State of School:
Zip of School:
Room #:
Cell Phone:	(reachable at time of workshop)
Troop Leader/Contact:
Approx number of girls:
Age of girls:
Home Address:
City:
Zip Code:
Contact Phone:
Email:
Would you like us to bring Patches? ($2 per patch)	Yes    No
Would you like us to bring t-shirts? ($15 per t-shirt)	Yes    No
Please note sizes here:
Please note any issues that you would like us to focus on during the workshop: