Tell us a little about you and your girl!

Please fill out the survey below to claim your girls first Girl Scout patch - for FREE! Patches will be mailed out to the address provided below in October 2018 on the official start of the 2018 membership year. One patch per girl member will be distributed.

We're so excited to kick off an amazing year of adventure! Questions? contact join@nccoastalpines.org to connect with a member of the Girl Scout team!

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* 1. Parent First Name

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* 2. Parent Last Name

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* 3. Girl First Name

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* 4. Girl Last Name

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* 5. Troop Number (if applicable)

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* 6. Mailing Address

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* 7. Email Address

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* 8. Phone Number

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