YOM Nomination

Years of Girl Scout Membership Recognition Request
Individuals who have been registered members for 50 years and higher (girl and adult years combined, in five year increments) will be recognized at the Volunteer Recognition Ceremony.

There is no charge for the pins if ordered by November 1st. Pins can be purchased through the GSMISTS Shop if the November 1st order deadline is not met.

Requests must be received by November 1st.
Requestor's Name:

First NameLast Name
Service Unit:
Service Unit Role:
Email:
example@example.com
Phone Number:
Format: (000) 000-0000.
Will someone from your service unit attend the Volunteer Recognition Ceremony in April?
Member Name

First NameLast Name
Years of Membership 50 + years
girl and adult years combined
Member Name

First NameLast Name
Years of Membership 50 + years
Girl and Adult years combined
Member Name

First NameLast Name
Years of Membership 50 + years
Girl and Adult years combined
Member Name

First NameLast Name
Member Name 50 + years

First NameLast Name
Member Name

First NameLast Name
Years of Membership 50 + years
Girl and Adult years combined
Should be Empty:

Years of Girl Scout Membership Recognition Request