Share Your Service & Request Your Patch
We’d love to hear how you helped make our project at Emily Green Shores special! Use this form to let us know if you: purchased an item from our Amazon Wishlist; mailed a card for residents; helped reduce elderly isolation in your community. You can also request a Portsmouth Service League patch. Patches are limited, so each person can receive one. Troops may request patches for multiple participants—just include information for each person.
All submissions will be reviewed by a PSL Provisional Member. Form closes Friday, April 10. Patches will be mailed or scheduled for pick up after the form closes.
Name
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Email
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Phone Number
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How are you addressing elderly isolation in your community?
Purchased an item off the Amazon Wishlist
Mailing a card to the Woman's Club of Portsmouth (304 Sycamore Rd, Portsmouth, VA 23707)
Other (If selected, please give a detailed description on the next page.)
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If you purchased an item off the Amazon Wishlist, please let us know which item(s):
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Please give a detailed paragraph on how you are addressing elderly isolation in your community.
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Are you registered as a Girl Scout, Boy Scout, or other organization?
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Yes
No
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Please provide your troop number.
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Would you like to receive a patch?
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Yes
No
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How many patches are you requesting? (Only one per person. Troops are welcome to request patches for multiple people at once.)
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Are you local and able to pick up your patch at a designated time from the Woman's Club of Portsmouth?
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Yes (You will be contacted to schedule pick up)
No
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Mailing address
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If the Portsmouth Service League offers a patch opportunity in the future, would you like to be contacted?
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Yes
No
Submit
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