New Membership Registration

Membership Registration
Please check one:*

New Girl(s) Membership OnlyNew Adult Membership OnlyNew Girl(s) and Adult(s) Membership
Adult Name (Primary Caregiver and/or Adult Member)*

First NameLast Name
Email*
example@example.com
Girl Troop (1st choice)
Girl Troop (2nd choice)
As the adult, I will be participating as:

Non-Volunteer and Caregiver/Family Member—I am a parent/guardian/family member of a Girl Scout and not volunteering at this time.
As an adult member, I will be participating as:

Volunteer available to help Girl Scouts within the troop or other opportunities as neededA caregiver or Girl Scout Alum who wishes to keep membership up to date without volunteering.at this time

When participating in Girl Scout activities, I give consent on my behalf and on behalf of the person(s) I am registering to be interviewed, photographed, videotaped, or electronically imaged for use in promotional materials, news releases, or other published formats by my local councils and/or Girl Scouts of the USA. The images will be the sole property of my local Girl Scout council and/or Girl Scouts of the USA. I and my heirs, successors and assigns hereby release and hold harmless my local Girl Scout council and/or Girl Scouts of the USA from any claim arising from the use of these materials.
Media Permissions*

I agree with the GSUSA Privacy Policy.I agree with Terms and Conditions.
SMS opt in - standard data and text messaging rates apply (optional).Email opt in - I agree to receive emails from GSUSA (optional).Phone opt in - I agree to receive information or telemarketing from GSUSA (optional).I agree with GSUSA photo policy (optional).
By checking above, I consent to receive customer care and account notification text messages (SMS or MMS), emails, or calls as indicated from Girl Scouts of North East Ohio. You may opt-out of text messages at any time by replying STOP, or for assistance, text HELP. Message frequency varies. Message & Data rates may apply. View TERMS (gsneo.org/terms) and PRIVACY (gsneo.org/privacy).
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/We acknowledge that the registrant will accept and abide by the Girl Scout Promise and Law and the registrant has permission to join Girl Scouts.
Signature*

Payment Method
Credit	Express

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

Any additional information we should know?
Should be Empty: