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!

Parent First Name

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* 1. Parent First Name

Parent Last Name

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* 2. Parent Last Name

Girl First Name

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* 3. Girl First Name

Girl Last Name

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* 4. Girl Last Name

Troop Number (if applicable)

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* 5. Troop Number (if applicable)

Mailing Address

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* 6. Mailing Address

Email Address

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* 7. Email Address

Phone Number

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* 8. Phone Number

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