Girls Clubs Charter Request Form
Email
*
example@example.com
Name of Church
*
Church File #
*
Church Phone Number
*
Please enter a valid phone number.
Church Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State/Regional Office
*
Please Select
Alabama
Alaska / B.C
Arizona
Arkansas
California/Nevada
Canada (Ontario)
Canada (Western)
Canada (Quebec/Maritimes)
Caribbean Region
Chicago (North Central Hispanic)
East Central Hispanic Region
Florida
Florida - Cocoa
Georgia (North)
Georgia (South)
Great Lakes Region (Chicago, Wisconsin)
Hawaii
Heartland Region (Oklahoma, Kansas
Illinois
Indiana
Kentucky
Louisiana
Maryland, Delaware, DC (Delmarva)
Michigan
Midland Region (Iowa, Nebraska)
Minnesota
Mississippi
Missouri
New England Hispanic Region
New Jersey
New Mexico
New York
North Carolina (Eastern)
North Carolina (Western)
North Central Region (North Dakota, South Dakota, Montana)
Northern New England Region (Vermont, New Hampshire, Maine)
North Central Hispanic Region
Northeastern Hispanic Region
Northwestern Hispanic Region
Ohio
Pacific Northwest Region
(Washington,Idaho, Oregon)
Pennsylvania
Rocky Mountain Region (Colorado, Utah, Wyoming)
Romanian Territory Office
South Carolina
South Central Hispanic
Southern New England Region (Connecticut, Massachusetts, Rhode Island)
Southeastern Hispanic Region
South West Hispanic Region
South West Indian Ministries
Tennessee
Texas
Virginia
West Virginia
State Girls Ministries Coordinator
*
Requested by
*
First Name
Last Name
Do you plan to participate in YLM?
Yes
No
How many membership cards do you need?
Do you plan to participate in Joy Belles?
Yes
No
How many membership cards do you need?
Do you plan to participate in Bluebelles?
Yes
No
How many membership cards do you need?
Do you plan to participate in Little Sweethearts?
Yes
No
How many membership cards do you need?
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