Girl Scout Adult Membership Form printable pdf download

Adult Membership

GIRL SCOUT MISSION

Girl Scouting builds girls of courage,

Join the global network of 2.6 million Girl Scouts

confidence, and character, who

Membership year through 9/30/2018

make the world a better place.

MEMBERSHIP OPTIONS

Check one:

� New Member

� Renewing Member

� Lifetime Member

� GSUSA ID (if known)

Annual Membership

� Annual fee: $25

Title or salutation:

� Mrs.

� Ms.

� Miss

� Mr.

� Dr.

� Other:

Lifetime Membership

(including permanent membership

Name: First

Middle

Last

card and recognition certificate)

� One-time fee of $400;

Address

Apartment

Adult 18 years or older who is

not a former girl member

City

State

Zip Code

or former girl member who is

30 years or older

(

)

(

)

Home Phone

Business Phone

Young Alumnae Lifetime

Membership

(

)

Cell Phone

Email Address

� One-time fee of $200;

Former girl member who is

18 to 29 years old

Employer

Title/Occupation

I wish to opt in: �Texts

By signing here and checking the circle to the left, each signee (and on behalf of the girl,

YES! I

would also like to make a

as applicable) agrees to receive auto dialed informational or marketing text messages

donation today that directly

at the cell number above, understanding such consent is not required to join.

benefits girls in our area. Enclosed

is my tax-deductible donation.

Gender:

Number of years in

Date of birth:

Girl Scouts respects and welcomes

Check one:

� Female

Girl Scouting:

people from all backgrounds and abili-

� $500

� $250 � $150

� Male

As a girl:

yyyy

ties. By completing the following infor-

As an adult:

mation (as defined by the U.S. Census

� $100

� $50

� $25

I am (Check all that apply.):

I am Hispanic or Latina:

Bureau), you ensure support and

� Other: $

funding for girls in your community.

� American Indian

� White

� Yes

Hispanic/Latina is defined as an

or Alaskan Native

� Other (Please specify)

� No

PAYMENT INFORMATION

� Asian

� I choose not to share

ethnicity, not a race, therefore

� Black or African American

� I choose not to share

at this time.

reported separately. This information

Annual Membership: $

� Hawaiian or Pacific Islander

at this time.

is used for statistical purposes only.

Lifetime Membership: $

I will be participating in Girl Scouting as (Check all that apply.):

Young Alumnae

� Volunteer —I am/will be volunteering for Girl Scouts.

� Community partner

Lifetime Membership: $

� Parent/family —I am a parent/guardian/family member of a Girl Scout.

� Staff—I am/will be employed by Girl Scouts.

Donation: $

� Girl Scout alumna —I was a Girl Scout, either as a girl, adult, or both.

� Other

Total Attached: $

As a volunteer, I would like to participate in the following role(s):

Representing group(s)/troop(s)/service unit:

� 01—Advisor or leader for a group/troop

� Cash

� Check*

� 02—Assistant advisor or leader for a group/troop advisor/leader

� Amex � Discover

� 03—Support volunteer for a group/troop

� Visa

� MasterCard

� 11—Service team or unit volunteer

� Other

� 12—Learning facilitator

� Other (specify)

Name on Credit Card

Media Permission

The Girl Scout Promise

The Girl Scout Law

When participating in Girl Scout activities, I (or the

On my honor, I will try:

I will do my best to be

Credit Card #

person I am registering) give consent to be inter-

To serve God and my country,

honest and fair,

viewed, photographed, videotaped, or electronically

To help people at all times,

friendly and helpful,

imaged for the purposes of promotional materials,

And to live by the Girl Scout Law.

considerate and caring,

Expiration Date

news releases, or other published formats for either

courageous and strong, and

the local Girl Scout council or Girl Scouts of the USA.

When making the Girl Scout Promise,

responsible for what I say and do,

Signature

The images will be the sole property of the local Girl

individual members may substitute

and to

Scout council or Girl Scouts of the USA. I hereby

wording appropriate to their own spiritual

respect myself and others,

release and hold harmless the local Girl Scout council

beliefs for the word “God.”

respect authority,

Date

and Girl Scouts of the USA from any claim arising from

use resources wisely,

*Make checks payable to Girl Scouts.

the use of these images.

make the world a better place, and

be a sister to every Girl Scout.

� I wish to opt out at this time.

THANK YOU FOR

SUPPORTING GIRL SCOUTS!

Learn more about Girl Scouts at

I accept and abide by the Girl Scout Promise and Law:

Return this registration form, along with

the GSUSA annual membership fee or

Signature

Date

applicable lifetime membership fee to your

local council. Fees are not refundable or

Council Code:

Service Unit/Team:

Group/Troop:

transferable to another person.

Girl Scout Adult Membership Form

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