Lifetime Member Update Form
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1Lifetime Member Update Form
Lifetime members, please fill out this update form annually.
This ensures the council information remains current.
Voluntary information
Current lifetime member information - please print
GSUSA # __________
Status:
New member Re-registering member
We encourage you to
voluntarily provide the
Service unit number ___________ Primary troop number ____________
Troop info:
following information on racial
Additional troop numbers (if applicable) __________________________
background and ethnicity,
gender, age and education
Name (first, MI, last)
levels. This information will
Address ______________________________________________ Apt # _______
be used by Girl Scouts to help
City __________________________________ State ______ ZIP code
improve outreach efforts
and advance the Girl Scout
Phone __________________________ Cell phone
Movement.
Email
As a girl ___________ As an adult ___________
Please choose all that apply:
Years in Girl Scouting:
My racial background is…
Employer
American Indian or Alaskan
Occupation _________________________ Work phone
Native
Asian
Employer’s address
Black or African American
City __________________________________ State ______ ZIP code
Hawaiian or Pacific Islander
White
Position information
Other _____________
Check all the apply:
Check all the apply:
My ethnic background is…
Adult position name (code)
Troop #(s)
Adult position name (code)
Troop #(s)
Hispanic or Latino
________
________
Leader/Adviser (01)
DO-Dad
Not Hispanic or Latino
________
________
Asst. Leader/Adviser (02)
Service Unit Manager
________
________
Troop Committee Member (03)
Service Unit Co Manager
I am an adult…
________
________
Service Unit Team Member (11)
Fall Product Sale Chair
Female
________
________
Trainer (12)
Fall Product Sale Mom
Male
________
________
Member- No Defined Position
Service Unit Cookie Manager
________
________
Council Board Member (16)
Troop Cookie Sale Mom
My age range is…
________
________
Board Committee Member (16)
Community Organizer
18-29
________
Service Unit Camp Coordinator ________
Council Nominating Committee (17)
30-49
________
________
Campus Girl Scouts
Service Unit Treasurer
50 and up
________
________
Council Executive Staff (21)
Service Unit Registrar
________
________
Council Office Staff (22)
Special Service Adult
The highest education level I
________
Other
completed is…
Some high school
Permission statement
High school
Some college
I accept and agree to abide by the Girl Scout Promise and the Girl Scout Law. I understand that when
Associate’s degree
participating in Girl Scout activities I may be photographed for print, video or electronic imaging. I understand
Bachelor’s degree
that the images may be used in promotional materials, news releases, and other published formats for either the
Postgraduate
local Girl Scout Council or Girl Scouts of the USA. I acknowledge that the images will be the sole property of the
local Girl Scout Council or Girl Scouts of the USA.
Signature _________________________________ Date ___________________
We include race, ethnicity,
sexual orientation, national
Family partnership summary
origin, age, disability, economic
status and religion in our anti-
Donation enclosed in the amount of:
Payment method
discrimination policies.
$500
$50
Cash
$250
$25
Check - Made payable to “Girl Scouts”
For leaders only
$100
Other $ ________
Credit card (minimum $20)
My employer has a matching gifts
Visa
MasterCard
Discover
VS #1 ___________
Card # __________________________________
program. I have enclosed the form to
Expiration date ____________________________
double or triple my gift. Gifts of $25 or
VS #2 ___________
Cardholder signature ________________________
more will be listed in our annual report.
Date ____________
Printed name _____________________________
Girl Scouts of Central Indiana
2611 Waterfront Parkway East Drive Suite 100, Indianapolis, IN 46214
877.474.2248 317.924.6800
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