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Clarification

Name *

First

Last

Maiden Name (if applicable)

Did you have a camp name? If so, please list it.

Mailing Address *

Address Line 1

Address Line 2

City

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Zip Code

Contact Phone Number *

Secondary Phone Number (if applicable)

Date of Birth *

Were/are you registered as a Girl Scout? If so, what years? (Ex. 1960-1975)

Did you attend Camp Archbald as a camper? If so, what years? (Ex. 1960-1975)

Did you attend Camp Archbald as a counselor? If so, what years? (Ex. 1960-1975)

Have you ever volunteered for Girl Scouts in the Heart of PA? If so, what did you do and what year? (Ex. Troop leader, 2005-present)

Were you ever employed by Scranton Pocono Girl Scout Council or Girl Scouts in the Heart of PA? If so, what did you do and what year? (Ex. Membership Specialist, 1995)

Do you have a current certification in any of the following areas? (Check all that apply) *

Are you currently a troop leader? *

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No

If so, what is your troop number and service unit?

Do you want to receive our monthly newsletter? *

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Are you interested in volunteering with SoCA? *

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What is the best way for us to reach you? *

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