Year Pin Request Form
Requests must be received by March 31, 2026 to be provided in this membership year. Pins will be presented at the Volunteer Appreciation Dinners or through the service unit. These pin requests are for adult members only.
First Name
*
Pin Recipient
Last Name
*
Email Address
*
Pin Recipient
Phone Number
*
-
Area Code
Phone Number
Service Unit #
*
Membership Manager
*
Please Select
Dolly Laclair
Renee Rivera
Leah Bardo
Jensyn Burton
Callista Carrier
Sabrina Clemens
Amber Gosart
Sarah Graham
Pamela Baker Gratton
Crystal Jackson
Marnie Shaeffer
Katie Sylvester
Rachel Van Ness
Melissa Wagner
Becky Wright
I am eligible for and prefer to receive the following pin: (choose one)
*
Membership Numeral Guard
Volunteer Years of Service Award Pin
Cumulative years as a member of Girl Scouts
*
Please Select
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
Combined years of volunteer service (5 or more verifiable years)
*
Please Select
5
10
15
20
25
30
35
40
50
60
I am an adult member of GSNYPENN:
YES
NO
Do you plan to attend on of the Volunteer Appreciation Dinners?
Yes
No
Unsure
Submit Form
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