Registration and Membership

New Member Renewing Member Lifetime Membership

Mrs. Ms. Miss Mr. Dr.

First Name Middle Name Last Name

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Area Code Phone Number

By signing here and checking above, each signee (and on behalf of the girl, as applicable) agrees to receive auto dialed informational or marketing text messages at the cell number above, understanding such consent is not required to join.

Girl Scouts respects and welcomes people from all backgrounds and abilities. By completing the following information (as defined by the U.S. Census Bureau), you ensure support and funding for girls in your community. Hispanic/Latina is defined as an ethnicity, not a race, therefore reported separately. This information is used for
statistical purposes only.

Yes No I choose not to share at this time.

American Indian or Alaskan Native Asian Black or African American Hawaiian or Pacific Islander White I choose not to share at this time.

Volunteer—I am/will be volunteering for Girl Scouts. Parent/family—I am a parent/guardian/family member of a Girl Scout. Girl Scout alumna—I was a Girl Scout, either as a girl, adult, or both. Staff—I am/will be employed by Girl Scouts. Community Partner

Advisor or leader for a group/troop Assistant advisor Leader for a group/troop advisor/leader Support volunteer for a group/troop Service team or unit volunteer Learning facilitator

Rerun, or example Wed. 12/2 between 2-5pm

New Member Renewing Member

First Name Middle Name Last Name

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Area Code Phone Number

Both parents Mother/guardian only Father/guardian only

Yes, same address as the girl's No

First Name Last Name

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Area Code Phone Number

Yes, same address as the girl's No

First Name Last Name

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Area Code Phone Number

American Indian or Alaskan Native Asian Black or African American Hawaiian or Pacific Islander White I choose not to share at this time.

Yes No I choose not to share at this time.

When participating in Girl Scout activities, I (or the person I am registering) give consent to be interviewed, photographed, videotaped, or electronically imaged for the purposes of promotional materials, news releases, or other published formats for either the local Girl Scout council or Girl Scouts of the USA. The images will be the sole property of the local Girl Scout council or Girl Scouts of the USA. I hereby release and hold harmless the local Girl Scout council and Girl Scouts of the USA from any claim arising from the use of these images.

I wish to opt out at this time.

The Girl Scout Promise
On my honor, I will try:
To serve God and my country,
To help people at all times,
And to live by the Girl Scout Law.

When making the Girl Scout Promise,
individual members may substitute wording appropriate to their own spiritual beliefs for the word “God.”

The Girl Scout Law
I will do my best to be
honest and fair,
friendly and helpful,
considerate and caring,
courageous and strong, and
responsible for what I say and do,
and to
respect myself and others,
respect authority,
use resources wisely,
make the world a better place, and
be a sister to every Girl Scout.

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

Annual Membership $ 25.00

Lifetime Membership (One time fee) $ 400.00

Adult 18 years or older who is not a former girl member or former girl member who is 30 years or older.

Young Alumnae Lifetime Membership (One time fee) $ 200.00

Former girl member who is 18-29 years old.

Total $ 0.00

Payment Method

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country