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Please note that all on-line registrations must be paid by credit card. If you choose to pay by check, please complete the hard-copy version of the Tools to Lead Registration Form.
STEP 1 - ENTER YOUR CONTACT INFORMATION
First Name
*
Last Name
*
Street Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Home Phone
*
Work Phone (optional)
Girl Scout Position
*
Age Level
*
Daisy
Brownie
Junior
Cadette
Senior
Service Unit
*
Please complete the following question for us to update our records.
Have you ever taken 'New Leader Orientation'?
*
Yes
No
If Yes, what was the date of 'New Leader Orientation'
STEP 2 - ENTER YOUR COURSE INFORMATION
Course Title
*
Girl Scouting 101 - In-Person Training (no fee)
Troop Camper Certification Part 1 (no fee)
Troop Camper Certification Part 2 (no fee)
Extended Trips (no fee)
CPR Full Course Training ($35)
First Aid Full Course Training ($30)
CPR Review Training ($20)
First Aid Review Training ($20)
Adult Recognition Award/Nomination Training (no fee)
Date and Time of Course
*
Course Location
*
If you are signing up for additional courses, please use the space below.
Course Title
Girl Scouting 101 - In-Person Training (no fee)
Troop Camper Certification Part 1 (no fee)
Troop Camper Certification Part 2 (no fee)
Extended Trips (no fee)
CPR Full Course Training ($35)
First Aid Full Course Training ($30)
CPR Review Training ($20)
First Aid Review Training ($20)
Adult Recognition Award/Nomination Training (no fee)
Date and Time of Course
Course Location
Additional Comments
DO YOU HAVE ANY “BURNING QUESTIONS” YOU WOULD LIKE ANSWERED AT TRAINING?
Please help us better serve you by submiting any burning questions within this registration form (or on a separate paper if faxing). We will pass these questions on to your Trainer. Thank you!
STEP 3 - ENTER PAYMENT INFORMATION (if necessary)
Name as it appears on card
Type of Card
VISA
MASTERCARD
AMEX
DISCOVER
Credit Card Number
Exp Date
Total Amount Billed to Card
STEP 4 - ENTER YOUR EMAIL ADDRESS FOR CONFIRMATION
Please enter your email address to receive an auto generated reply from our server that your registration has been submitted successfully. Official training confirmation will be sent to you one week prior to the date of the training you have registered for.
Please complete the following question for us to update our records.
*
I would like to receive Girl Scouts of Northern New Jersey's monthly e-newsletter,
Discover Connect Take Action
, and other electronic updates about trainings, programs, and events.
(You can unsubscribe at any time.)
*
Yes
No
PLEASE REVIEW FORM TO MAKE SURE THAT ALL REQUIRED FIELDS (INDICATED BY *) ARE COMPLETED. THE FORM CANNOT BE SUBMITTED UNLESS THESE FIELDS ARE COMPLETED. CLICK ON REGISTER BUTTON TO COMPLETE REGISTRATION