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Girl Scout's Name:*
Address (include town):*
School Scout attends:*
Address (if different from above):
Scout Master's name:*
Sponsored by (Name of Organization and Town):*
Time, date, place of award ceremony:*
Description of Project (be specific, Include all aspects of how the project was completed.):*
List other Scouting Awards:
List other activities (such as club memberships):
All fields marked with * are required.
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