Delegate at Large Interest Form
Complete the form below if you are interested in serving as a delegate at large for Girl Scouts River Valleys.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Acknowledgments
Are you a current Girl Scouts River Valleys member?
*
Yes, I am a current member.
No, I am not a current member.
Are you an adult or Girl Scout member?
*
Girl Scout (Must be 14 years of age by October 1)
Adult
If no, don't worry and
join today
!
To be Completed by a Parent or Legal Guardian
I consent that Girl Scouts River Valleys can provide their services and communicate with me via mobile phone, messages, e-mail and any kind of online communications, provided that these communications comply with privacy regulations.
*
Yes, I agree.
No, I do not want to receive electronic communications.
Submit
Should be Empty: