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ZIP GIRL SCOUT REGISTRATION FORM - MENTOR New Registration Returning Registration Membership Registration 12. Girlscouts-gateway. org Training offers great resources and anticipates questions you may have as you mentor your ZIP Girl Scout. Mail this form to Girl Scouts of Gateway Council Inc. Membership Secretary - ZIP Registration 1000 Shearer Avenue Jacksonville FL 32205 FOR OFFICE USE ONLY Date Received GS Svc Unit Print Form Area Coordinator. 00 VALID THROUGH 9/30/20 MENTOR S FIRST MIDDLE LAST NAME Street Address Apt City St Zip Occupation Home Phone Employer Ext Work Phone Email I AM THE MENTOR FOR Girl s Name Address if different Phone The registrant s racial background is please check as many as apply American Indian or Alaskan Native Asian Black or African American Hawaiian or Pacific Islander White Other Please specify Hispanic or Latina Non Hispanic or Latina The Girl Scout membership year is from October 1st through September 30th. Financial Assistance is available. Enclosed is my check for GSUSA membership dues 12. 00 Credit Card MasterCard or VISA only amount must be 10 or above For security reasons please hand-write your CC above Exp Date Name as it appears on card I am registered with Troop Signed By Date If you have not taken a ZIP Mentor Training already please check the Adult Training Booklet for the next available course or online at www. girlscouts-gateway. org Training offers great resources and anticipates questions you may have as you mentor your ZIP Girl Scout. Mail this form to Girl Scouts of Gateway Council Inc* Membership Secretary - ZIP Registration 1000 Shearer Avenue Jacksonville FL 32205 FOR OFFICE USE ONLY Date Received GS Svc Unit Print Form Area Coordinator. 00 VALID THROUGH 9/30/20 MENTOR S FIRST MIDDLE LAST NAME Street Address Apt City St Zip Occupation Home Phone Employer Ext Work Phone Email I AM THE MENTOR FOR Girl s Name Address if different Phone The registrant s racial background is please check as many as apply American Indian or Alaskan Native Asian Black or African American Hawaiian or Pacific Islander White Other Please specify Hispanic or Latina Non Hispanic or Latina The Girl Scout membership year is from October 1st through September 30th. Financial Assistance is available. Enclosed is my check for GSUSA membership dues 12. 00 Credit Card MasterCard or VISA only amount must be 10 or above For security reasons please hand-write your CC above Exp Date Name as it appears on card I am registered with Troop Signed By Date If you have not taken a ZIP Mentor Training already please check the Adult Training Booklet for the next available course or online at www. Financial Assistance is available. Enclosed is my check for GSUSA membership dues 12. 00 Credit Card MasterCard or VISA only amount must be 10 or above For security reasons please hand-write your CC above Exp Date Name as it appears on card I am registered with Troop Signed By Date If you have not taken a ZIP Mentor Training already please check the Adult Training Booklet for the next available course or online at www. girlscouts-gateway. org Training offers great resources and anticipates questions you may have as you mentor your ZIP Girl Scout..

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