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Girl Program Idea Submission

iMIS Number:

Please enter your iMIS Number

First Name:

Last Name:

Street Address:

Enter Unit number (if applicable), street number, street name, and RR number or box number (if applicable). e.g. 1006-360 Torrence St PO Box 371

City/Town:

Province/Territory:

Community Number:

Unit Name

e.g. 3rd North Bay Guides

Primary Phone Number:

Please include area code first

Secondary Phone Number:

Please include area code first

E-mail Address:

Name of activity:

Description of activity:

Is this activity a

game craft science (STEM) activity recipe

This activity is best suited for:

Sparks Brownies Guides Pathfinders Rangers

Please tick all that apply.

Minimum # of participants required:

Maximum # of participants:

Time required:

Materials needed:

Instructions:

Facility requirement:

i.e. kitchen, running water etc.

Is this an indoor or outdoor activity?

Indoor Outdoor Both

What is the program connection?

Describe what component, badges or keepers are a part of this activity.

Submit photo of your idea:

Submit photo of your idea:

Submit photo of your idea:

Enter the code

retype the code you see in black letters (beside the box)

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