GO! Dough Usage Form

GO! Dough Usage Request Form

If you have any questions regarding this form, please contact Member Services at 717-233-1656 or email us at memberservices@gshpa.org
Name of Parent/Guardian Requesting GO! Dough:

First NameLast Name
Requester Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Requester Email:
example@example.com
Please list all Girl Scouts requesting GO! Dough.
I am requesting to use GO! Dough for:

Girl Scout or Household Member(s)

Name of Girl Scout Purchasing a Lifetime Membership:

First NameLast Name
Email for New Lifetime Member:
example@example.com

Name of GSHPA Program:
Start Date of GSHPA Program:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Choose your requested gift card(s) and quantities:

Rows	Select Online Shop & Quantity
$10.00 Gift Card
$25.00 Gift Card
$50.00 Gift Card
$100.00 Gift Card

Recipient Email for Digital Gift Cards:
example@example.com

Other (To be considered include all details)

I acknowledge that this request will deduct funds from my Girl Scout's GO! Dough balance.
Please verify that you are human
Should be Empty: