Girl Alternative Payment Form

Alternative Payment Form for Membership/Forma de registro de Girl Scouts

Girl Scouts of Greater Atlanta welcomes girls and adults in select volunteer roles in any financial situation. In order to remove financial barriers that may interfere with participation, we make funds available to cover membership to ensure that all get the opportunity to experience our quality Girl Scout programming. Girl Scouts of Greater Atlanta da la bienvenida a niñas y adultos en roles voluntarios selectos en cualquier situación financiera. Con el fin de eliminar las barreras financieras que pueden interferir con la participación, ponemos a disposición fondos para cubrir la membresía para garantizar que todos tengan la oportunidad de experimentar nuestra programación de Girl Scouts de calidad.
Please use this form if a Check, Cookie Dough, or Financial Aid is required to complete a Girl Scout membership request for a Girl or an Adult.

Girl Scouts of Greater Atlanta partners with select insurance providers to support membership participation. Individuals covered by PeachState or CareSource are required to upload a clear image of their insurance card as part of the submission process.

Por favor use este formulario si se requiere un Cheque, Masa de Galletas o Ayuda Financiera para completar una solicitud de membresía de Girl Scout para una Niña o un Adulto.

Girl Scouts del Gran Atlanta se asocia con proveedores de seguros seleccionados para apoyar la participación en la membresía. Las personas cubiertas por PeachState o CareSource deben subir una imagen clara de su tarjeta de seguro como parte del proceso de envío.
New member/Nuevo miembroReturning member/Miembro que regresa
Membership Year 2027-$65 Annual membership valid 10/1/2026 - 9/30/2027Membership Year 2026 -$45 Annual membership valid 10/01/25 - 9/30/26
Alternative Payment Options*
Troop Number (if known)/Número de tropa (si lo sabe)
Girl Membership Payment Method/Metodo de pago de membresia de nina*
NOTE: Amerigroup subscribers are required to request a Youth Club Membership Card:

Benefit eligibility: members ages 6-18 with completed annual well check. One card per member per year.
- Subscribers can request via the Amerigroup Benefit Rewards Hub, located in member portal: https://member.amerigroup.com/public/login
- Subscribers will need to log into their secure portal and click on Benefit Rewards Hub.
- Select Youth Club Membership Card – if eligible.
- Amerigroup will mail the Youth Club Membership Card within 7-14 days for eligible subscribers.
- Caregivers will log into MyGS to complete the girl membership using the Youth Club Membership Card.
For more details on how to request this benefit, Amerigroup members can visit: https://www.myamerigroup.com/ga/your-plan/georgia-families-medicaid.html or call Member Services at 800-600-4441 (TTY 711), Monday through Friday from 7 am to 7 pm EST.

Youth Club Membership Card is live now; Amerigroup subscribers can call or go online to request.
I am able to pay a portion of the annual membership fee, to be mailed to council (5601 North Allen Road SE, Mableton, GA 30126), in the amount of:
I am able to pay a portion of the annual membership fee, to be mailed to council at 5601 North Allen Road SE, Mableton GA 30126, in the amount of:
Girl's Name/Nombre de nina*

First Name/Primer NombreLast Name/Apellido
Girl's Date of Birth/Fecha de nacimiento de la nina*

MonthDayYear
Date/Fecha
American Indian or Alaskan Native/Indio americano o nativo de AlaskaAsian/Pacific Islander/Asiatico/Isleno del PacificoBlack or African American/Negro o afroamericanoWhite/Blanco (caucasico)Other Races/Otras razasMultiple Races/Multiples razasI Choose Not to Share/Elijo no compartir
Hispanic/HispanoNon-Hispanic/No-HispanoI choose not to share/Elija no compartir
Full Name of School Attending/Nombre completo de la escuela a la que asiste*
Current Grade/Grado actual*
Caregiver's Name/Nombre del encargado (padre, madre, tutor)*

First Name/Primer NombreLast Name/Apellido
Caregiver's Email/Correo electronico del encargado*
example@example.com
Caregiver's Address/Direccion del encargado*

Street Address/Direccion

Street Address Line 2/ Direccion de calle Linea 2

City/CiudadState / Provincia del estado

Postal / Zip Code / Codigo Postal
Caregiver's Phone Number/Numero de telefono del encargado*
Please enter a valid phone number.Format: (000) 000-0000.
Caregiver's Date of Birth/Fecha de nacimiento del encargado*

MonthDayYear
Date/Fecha
American Indian or Alaskan Native/Indio americano o nativo de AlaskaAsian/Pacific Islander/Asiatico/Isleno del PacificoBlack or African American/Negro o afroamericanoWhite/BlancoOther Races/Otras razasI choose not to share/Elijo no compartir
Hispanic/HispanoNon-Hispanic/No-HispanoI choose not to share/Elijo no compartir
Volunteer Position/Puesto de Voluntario
Communication/Comunicacion
I wish to opt out of receiving text messages from Girl Scouts of Greater Atlanta at this time. Deseo optar por no recibir mensajes de texto de Girl Scouts of Greater Atlanta en este momento.
I wish to opt out of receiving email messages from Girl Scouts of Greater Atlanta at this time. Deseo optar por no recibir mensajes de correo electronico de Girl Scouts of Greater Atlanta en este momento.
When participating in Girl Scout activities I may be photographed for print, videotaped, or electronically. Images may be used in promotional materials, news releases, and other published formats for either Girl Scouts of Greater Atlanta or Girl Scouts of the USA. The images will be sole property of Girl Scouts of Greater Atlanta or Girl Scouts of the USA. Cuando participo en actividades de Girl Scouts, puedo ser fotografiado para imprimir, grabar en video o electrónicamente. Las imágenes se pueden usar en materiales promocionales, comunicados de prensa y otros formatos publicados para Girl Scouts of GreaterAtlanta o Girl Scouts of the USA. Las imagenes serán propiedad exclusiva de Girl Scouts of Greater Atlanta o GirlScouts of the USA.

I wish to opt out at this time/Deseo darme de baja en este momento
Membership Registration and Acceptance/Registro y aceptacion de miembros
Yes, I will/Si, lo hare

Alternative Payment Form for Membership/Forma de registro de Girl Scouts

Communication/Comunicacion

Membership Registration and Acceptance/Registro y aceptacion de miembros