E-mail Address:
Day-time Phone #:
Troop # (if troop afiliated):
Are you a registered Girl Scout? Yes No
What Volunteer Positions would you be interested in?
  Volunteering with a Troop
    Grades K-1 Grades 2-3 Grades 4-5
    Grades 6-8 Grades 9-10 Grades 11-12
  Volunteering at a Day Camp
    Madison County St Clair County Effingham County
    Jefferson County Jackson County Bond County
    Monroe County Massac County  
  Volunteering with a Series (short term troop focused on a specific topic
    BFF (Be A Friend First): Anti-Bullying Program
    STEM Series (Science, Technology, Engineering and Math)
Ideal Volunteering Duration: Check all that apply
    Occasional (eg, Single events) Four to Six Months
    One to Twelve weeks One Year
How far are you willing to travel to volunteer?
    Less than 5 miles 5-10 miles 10-25 miles
    25-50 miles Over 50 miles  
Any Additional Comments?



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