Service Unit. Email Address: #: :______. Items Requested: American Flag #. Girl Scout Flag #. *Brownie Girl Scout Flag #
Ceremonial Equipment Request Form Name: Address: City:
State:
Phone: Home: (
)
Work: (
)
Zip: Cell: (
)
Troop # ___________________________________ Service Unit ______________________________________ Email Address: _______________________________________DL #:______________________State:_________ Items Requested: American Flag #
Girl Scout Flag #
*Daisy Girl Scout Flag # *Large Wood Bridge
*Brownie Girl Scout Flag #
World Association Flag # *Small Wood Bridge
*Girl Scout Tablecloth
Flag Stands # *Candles / Candle Holders
Cookie Costumes (minimum of 2) # Other – describe and specify number:
Date items to be picked-up:
Date items to be returned (3 day limit)
Name of person picking up items: *Not all items available in every area – check with your local office Please complete form and forward to the Front Desk Reception at the nearest Regional Office. Contact Information Memphis, TN Regional Office: Contact: Toulasone Sivilay Phone: 901-767-1440 Fax: 901-797-2183
Email:
[email protected]
Tupelo, MS Regional Office Contact: Joann Rogers Phone: 662-350-6042
Fax: 662-840-1671
Email:
[email protected]
Jackson, TN Regional Office Contact: Shelia Deaton Phone: 731-215-6127
Fax: 731-661-0011
Email:
[email protected]
www.girlscoutshs.org Corinth, MS: 1901-C S. Harper Rd., Corinth, MS 38834 l mail: P.O. Box 1145, Corinth, MS 38835 l p: 662.287.8321 l f: 662.287.5338 Jackson, TN: 1007 Old Humboldt Rd., Jackson, TN 38305 l p: 731.668.1122 l f: 731.661.0011 Memphis, TN: 717 S. White Station Rd., Ste. 2, Memphis, TN 38117 l mail: P.O. Box 240246, Memphis, TN 38124-0246 l p: 901.767.1440 l f: 901.797.2183 Tupelo, MS: 1140 W. Main St., Tupelo, MS 38801 l mail: P.O. Box 1087, Tupelo, MS 38802 l p: 662.844.7577 l f: 662.840.1671 Updated 08/2014 Page 1 of 1
