Juliette Gordon Low Society Confidential Enrollment Form

Juliette Gordon Low Society Confidential Enrollment Form
To join the Juliette Gordon Low Society, please use the web form below or print and fill out the paper form.

In consideration of the impact that Girl Scouting has on the lives of girls, I/we have made provision for a gift to Girl Scouts of the Green and White Mountains (GSGWM) in my/our estate plan. Understanding that Girl Scouts of the USA (GSUSA) has established the Juliette Gordon Low Society to recognize individuals who made such a commitment, I/we are pleased to authorize GSGWM to include me/us as a member of the Juliette Gordon Low Society.
Name

PrefixFirst NameLast NameSuffix
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse's Name (if different than your own)

PrefixFirst NameLast NameSuffix
Spouse's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship with Girl Scouts

Other
If different from the format above, please let us know how you would like your name to appear for recognition purposes.
Gift Information
I/we qualify for the Juliette Gordon Low Society through the following planned gift:

Other
Please indicate the approximate current market value of the planned gift named above:
(This will be treated as confidential.)
The gift is:

Restricted as follows:
I/we wish to remain an anonymous member of the Juliette Gordon Low Society.
May we share your name with GSUSA to be included on the national JGLS listing? (No other contact or gift information will be shared without your consent.)
Signature
Date of Submission

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse's Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please verify that you are human
Should be Empty:

Juliette Gordon Low Society Confidential Enrollment Form

Gift Information