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Alternate Payment Registration Form
Alternate Payment Registration Form
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to downloand the Opportunity Grant Form
Alternate Payment Registration Form
Registrant Information - One registrant per form
Please note that this form is for events and trainings only. This form can not be used for membership registration, troop/family camp or summer camp registration.
Name:
First
Last
Address
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
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AS
FM
GU
MH
MP
PW
PR
VI
AA
AE
AP
State
Postal Code
Home Phone:
Area Code
Phone Number
Cell Phone:
Area Code
Phone Number
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Troop #/Juliette:
Grade Level:
Daisy: K-1
Brownie: 2-3
Junior: 4-5
Cadette: 6-8
Senior: 9-10
Ambassador: 11-12
Adult
Event or Training Information
Name of event/training registering for:
Date of event/training:
Location of event/training:
Alternate Payment Information *Please select an option below*
Please note that cookie credits can NOT be used for Adult Training
Cookie Credit - Enter the full number below
A link to the Opportunity Grant form is at the top of the page.
Opportunity Grant - Please send Opportunity Grant form to the Denver Service Center, attn: Events and Training Registrar
Yes
No
Check - All checks must be sent to the Denver Service within 10 days of submitting this form. If your check is not recieved within 10 days, you will NOT be placed into the event.
Yes
No
Comments
Instructions
Please send all opportunity grant applications and checks to the Denver Service Center - 400 S. Broadway PO Box 9407 Denver, CO 80209 Attn. Events and Training Registrar.
If an event or training is at capacity or past the registraton deadline when this form is submitted you will not be placed into the event or training.
Please note that this form is for events and trainings only. This form can not be used for membership registration.
For more information or for clarification please contact Stephanie Lester at stephanie.lester@gscolorado.org or 303-6074882
I have read the above instructions and agree to the terms of the form
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No
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