NOTIFICATION OF CHIEF SCOUT'S GOLD AWARD

Please complete the details below IN BLOCK CAPITALS and send the form to David Hawkins – CSGA Admin,Flat 4, 84 Guildford Road, Lightwater, Surrey GU18 5RY or email to csga@surrey-scouts.org.uk.

The information will be used for preparing the certificate and inviting the Scout and Leader to a future CountyChief Scout's Award Presentation of certificates.

Please note that the name entered for the recipient will be the name printed on the Award Certificate.

Certificate Details

First Name:

Surname:

Scout Group:

District:

Date of Award:

Scout’s address for invitationAddress:

Postcode:

Scout’s Telephonenumber:

Scout’s email:

Scout Leader’s address for invitation

Address:

Postcode:

Scout Leader’sTelephone number:

Scout Leader’s email:

Scout Leader’s Name:

Signed (SL)

Signed (ADC)

Date:

Date:

CSGA 2018 001