*First Name:
*Last Name:
*Email:
*Phone:
Address where you would like the materials sent: (Please note: Materials cannot be sent to PO boxes.) *Street Address:
*City:
*State:
*ZIP code:
The free patch program for Girl Scouts is currently only available to girls in the following councils: Central Indiana; Heart of Michigan; Michigan Shore to Shore; North East Ohio; Southeastern Michigan; Northern Indiana Michiana; Kentuckiana (Indiana troops only) and Southwest Indiana. If not part of an organized troop, please indicate "Juliette" in the fields below.
*Council:
*Troop Number:
Indicate the number of scouts in your troop:
Daisies:
Brownies:
Juniors:
Cadettes:
Seniors/Ambassadors:
Total Number of Girls:
Would you like to receive a printed copy of the curriculum?:
Would you like to receive a selection of oral health storybooks, including a copy of "Throw Your Tooth On The Roof"?:
Science Activity Cards:
Brushing and Reading Charts:
Rethink Your Drink Brochures:
Toothbrushes:
If you have questions, need assistance, or are interested in receiving information about the Delta Dental Foundation's oral health programs and activities, please contact Megan Schreier at mschreier@deltadentalmi.com.