Participation Form
Holocaust Education Girl Scout Patch
Your name
*
First Name
Last Name
Your email
*
example@example.com
Your phone number
*
Please enter a valid phone number.
What is your role?
*
Troop Leader
Girl Scout
Parent of a Girl Scout
Other
Where are you located? (City, State/Country)
*
Your troop's ZIP code
*
How many Scouts are in the troop?
*
What are the ages of the Scouts in your troop?
*
Roughly, when do you plan on completing the patch program curriculum?
*
Do you have any questions about the patch program?
Submit
Should be Empty: