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

Street Address

Street Address Line 2

City State / 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 Year 10 Year 15 Year 20 Year 25 Year 30 Year 35 Year 40 Year 45 Year 50 Year 55 Year 60 Year 65 Year 70 Year 75 Year 80 Year 85 Year
What Volunteer Years of Service Pin are you requesting?

20 Year 25 Year 30 Year 35 Year 40 Year 45 Year 50 Year 55 Year 60 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 43537 I will pick up at the Lima Girl Scout Center: 1870 West Robb Ave., Lima, OH 45805 I will pick up at the Dayton Girl Scout Center: 450 Shoup Mill Rd., Dayton, OH 45415 I 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