Please return Nomination Form to:
Girl Scouts of Greater New York
Volunteer Recognition Committee
40 Wall Street, Suite 708, New York, NY 10005
Nomination Form for Years of Membership Numeral
Due on or before November 15th
Nomination for: (Please check which applies)
Nominee's Name: _______________________________________________________
Address: _______________________________________________________________
City _______________________ State ____________________ Zip _______________
Telephone (Day) ______________________ (Evening) __________________________
E-mail address __________________________________________________________
Troop # _____________ Service Unit _______________ Borough _________________
Submitted by - if different from above:
Name:_________________________________________________________________
Address _____________________ City ____________ State ________ Zip__________
Telephone (Day) __________________________ (Evening) ______________________
E-mail address __________________________________________________________
Service Unit, committee or task group ________________________________________
YEARS OF MEMBERSHIP:
The Number of Years as a Registered Girl in any Girl Scout/Girl Guide organization plus
the number of years as a registered adult. Please indicate dates:
From: _______________ To: _______________________
Number of Years as a Registered Girl ___________ Please indicate dates:
From: _______________ To: _______________________
Number of Years as a Registered Adult __________ Please indicate dates:
From: _______________ To: _______________________
Girl Scout Council in which you were registered ________________________________
______________________________________________________________________
______________________________________________________________________
Appendix 2
TO BE COMPLETED BY THE RECOGNITION COMMITTEE
BOROUGH RECOGNITION COMMITTEE ___ ENDORSES
___ DOES NOT ENDORSE THIS NOMINATION
________________________________
SIGNATURE OF CHAIR
______________________
DATE
REVISED 7-2015