Adult Engagement Form

Name

Spouse’s Name

Address

Telephone

Employer/Occupation

Birthday Month

Communication Preference

Newsletter – Email (6 times per year)

Newsletter – Paper (1 time per year)

Annual Letter

Face to face conversation

Phone Call

Select all that apply

Other?

Around what year did you join Girl Scouts?

Are you a Lifetime Member?

Yes

If not, are you interested?

Yes

Are you part of a Girl Scout Alum Group?

Yes

Group Name

Have you included Girl Scouts as a beneficiary to a will, retirement plan, savings account, or similar?

Yes

Please share any highlights of your Girl Scout experience, such as awards earned and camp.

Would you be willing to volunteer?

Yes

Not right now, but check back with me.

When?

Other?