Girls Empowered Troop/Scout Workshop Request Form

Workshop Requested:
Date of Workshop:	1^st choice, 2^nd choice,
Time of Workshop:	(start time after snack!)
Workshop location:	(Name of school or other)
Location address:
Location city:
Location state:
Location zip:
Room #:
Cell phone:	(reachable at time of workshop)
Contact name:
Approx number of girls & boys:
Age of children:
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 as an option to buy? ($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: