AJAX Paving the Way to Success Program - Free Patch Order Request

AJAX Paving the Way to Success Program Free Patch Order Request

Thank you for participating in our Free Patch Program! We’re excited to offer these fun patches to members. Please complete the form below to request your patches for the AJAX Paving the Way to Success Program. Remember, they are available while supplies last, and if you choose the shipping option, a shipping fee will apply. Full details can be found in the patch descriptions on gswcf.org/patchprograms.
Troop Leader/Adult Name*

First NameLast Name
Girl Scout Council Name*

Girl Scouts of West Central Florida (GSWCF)Girl Scouts of Citrus (GSC)Girl Scouts of Gateway (GSG)Girl Scouts of Gulfcoast Florida (GSGCF)Girl Scouts of Southeast Florida (GSSEF)Girl Scouts of Tropical Florida (GSTF)Other
If picked other please input below.
Troop Number*
County*
Email*
example@example.com
Phone Number*
What is your preferred form of contact?

EmailPhone (Call)Text
AJAX Paving the Way to Success Patch*
Number of girls completed patch program
Patch Pickup Notice: Please ensure you make arrangements to collect your patches at the leadership center once order is filled.*

Pick up my patchShipping
If you selected shipping, please provide the address where your patches should be sent:
Patches can only be shipped to one address, splitting orders and shipping to separate locations is not available.
Was this patch program easy to implement?*

Very EasySomewhat easyNeutralA bit difficultVery Difficult
Did the girls enjoy the activities?*

YesSome Liked itNot ReallyOther
Would you recommend this patch to other leaders?*

YesMaybeNoOther
How much did the girls learn about roads and construction?*

A lotA littleNot SureOther
Age levels of your troop (Click all that apply)*

DaisiesBrowniesJuniorsCadettesSeniorsAmbassadors
We'd love feedback? *
Let us know what your girls loved best?
Upload any pictures to share with our funders of your patch work!*

Example: Pictures of activities, site visits, etc.
Cancelof
My Products
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ShippingFirst Class Shipping
$5.95

Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
*You will receive an email once the patches have been shipped if you chose the shipping option, or when they are ready to be picked up at the Leadership Center during business hours.
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AJAX Paving the Way to Success Program Free Patch Order Request