Membership Year & Volunteer Years of Service Pin Request

Membership Year & Volunteer Years of Service Pin Request
Use this form to request your Girl Scout Membership Pin and your Volunteer Years of Service Pin-20 (+) years and higher. These are awarded in five-year increments.

All pin requests are due by February 1.
Your Information
Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number (optional)
Please enter a valid phone number.
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What pin(s) are you requesting?*

Membership Year (includes years as both a girl member and adult member!)Volunteer Years of Service
What Girl Scout Membership Pin are you requesting?

5 Year10 Year15 Year20 Year25 Year30 Year35 Year40 Year45 Year50 Year55 Year60 Year65 Year70 Year75 Year80 Year85 Year
What Volunteer Years of Service Pin are you requesting?

20 Year25 Year30 Year35 Year40 Year45 Year50 Year55 Year60 Year
How would you like to receive your pin(s)?*

Please give to the service unit for distribution (often given out at volunteer appreciation events in April/May)I will pick up at the Toledo Girl Scout Center: 460 W. Dussel Drive, Suite A., Maumee, OH 43537I will pick up at the Lima Girl Scout Center: 1870 West Robb Ave., Lima, OH 45805I will pick up at the Dayton Girl Scout Center: 450 Shoup Mill Rd., Dayton, OH 45415I will pick up at the Cincinnati Girl Scout Service Center: 4930 Cornell Rd., Cincinnati, OH 45242
What service unit should we send your membership year pin to?
Should be Empty:

Membership Year & Volunteer Years of Service Pin Request

Your Information