500+ Cookie Club Member
Information Form 2017
Two or more girls from the same family may combine boxes for eligibility. Complete a separate form for each 500+ girl.
Name of girl: __________________________________________________________________ SU #: _______ Troop #: ___________
# of boxes sold: _____________
T-shirt size: (circle one) YS YM YLG AS AM ALG AXL A2X A3X
1000+ Level: (choose one item): □ Luggage Set □ Geocache GPS 1500+ Level: (choose one item): □ Camping Set □ Beats Headphones
2000+ Level: (choose one item): □ Drone □ 1 Week @ GSCB Resident Camp
Mailing address: __________________________________________________________________________________________________
City: _______________________________________________________
State: _________________
Zip: ______________________
Parent/Guardian name: ____________________________________________________________________________________________
Phones: (Day) ________________________ (Cell) ______________________ Email: ________________________________________
Sibling information (if applicable):
Name: ______________________________________________________ Troop #: ___________ Number boxes sold: ____________
Name: ______________________________________________________ Troop #: ___________ Number boxes sold: ____________
eBudde Sister Reward Order Entered Under Troop #: ______________
Sisters Total Sold: _____________
Each girl will receive her own $15 Girl Scout membership certificate for 2017-2018, secret surprise and 500+ patch. Sisters combining to reach 500+
will share the value of this 500+ club package. S’mores maker, Luggage Set, Geocache, Beats Headphones, Camping Set, Drone & iPad Pro, where
applicable, will be mailed by GSCB directly to the address provided above. (Accessories, including power cords, for these products are not included.)
Other rewards will be distributed by the Service Unit Cookie Manager. *Submit forms to GSCB with final paperwork.
500+ Cookie Club Member
Information Form 2017
Two or more girls from the same family may combine boxes for eligibility. Complete a separate form for each 500+ girl.
Name of girl: __________________________________________________________________ SU #: _______ Troop #: ___________
# of boxes sold: _____________
T-shirt size: (circle one) YS YM YLG AS AM ALG AXL A2X A3X
1000+ Level: (choose one item): □ Luggage Set □ Geocache GPS 1500+ Level: (choose one item): □ Camping Set □ Beats Headphones
2000+ Level: (choose one item): □ Drone □ 1 Week @ GSCB Resident Camp
Mailing address: __________________________________________________________________________________________________
City: _______________________________________________________
State: _________________
Zip: ______________________
Parent/Guardian name: ____________________________________________________________________________________________
Phones: (Day) ________________________ (Cell) ______________________ Email: ________________________________________
Sibling information (if applicable):
Name: ______________________________________________________ Troop #: ___________ Number boxes sold: ____________
Name: ______________________________________________________ Troop #: ___________ Number boxes sold: ____________
eBudde Sister Reward Order Entered Under Troop #: ______________
Sisters Total Sold: _____________
Each girl will receive her own $15 Girl Scout membership certificate for 2017-2018, secret surprise and 500+ patch. Sisters combining to reach 500+
will share the value of this 500+ club package. S’mores maker, Luggage Set, Geocache, Beats Headphones, Camping Set, Drone & iPad Pro, where
applicable, will be mailed by GSCB directly to the address provided above. (Accessories, including power cords, for these products are not included.)
Other rewards will be distributed by the Service Unit Cookie Manager. *Submit forms to GSCB with final paperwork.