Muscatine SU Cookie Rally

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If registering more than one scout, please submit second form.

Please use this form to register for an event sponsored by our Muscatine County Service Unit 836. You will receive a confirmation email once you submit registration.

Email *

Girl Scouts Name

Scouts Troop #

Name of Adult Attending (Enter none if not staying)

Emergency Contact During Event

Emergency Contact Phone Number

Total Amt Due - $2 per Scout

Form of Payment

PayPal ~ click paypal.me/muscgirlscouts (Add scouts name to comments)

Cash/Check Payable to Girl Scouts~ send payment to: Jessica Pierce 1211 Logan St. Muscatine, IA 52761

Program Credit ~ please fill out next section

Scout Program Credit Account Number

Scout Program Credit Account CVV Number

Scout Program Credit Amount to use

A copy of your responses will be emailed to the address you provided.

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