Adult Membership Form: Tell Us About You!
Girl Scout membership is good through 9/30/2025.
Already a member? Renew
here
.
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Gender
*
Please Select
Female
Male
I choose not to share.
Birth Date
*
-
Month
-
Day
Year
Date
Ethnicity
*
Please Select
Hispanic
Non-Hispanic
I choose not to share.
Staff Only - Family did not report ethnicity.
Race (Check all that apply.)
*
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or Pacific Islander
White
Other Races
I choose not to share.
Staff Only - Family did not report race.
Were you a Girl Scout Daisy, Brownie or higher, it all counts?
*
Yes
No
Volunteer Role Desired - Let us know what you'd like to do with Girl Scouts and we'll find the role that is the right fit. Some roles are: Troop Leader, Troop Co-Leader, Troop Helping Hand, Troop Cookie Chair, and Troop Fall Product Chair. You can also help out beyond the troop. If you want to help a troop, please let us know the Troop Number or Troop Leader's name.
Please make sure that I am connected to my girl in your system.
Girl's Name
Power the Promise
Girl Scouts of Kentuckiana has pledged that finances will not be a barrier to joining! This year, our community has stepped up to help us Power the Promise and make Girl Scouts accessible to all girls.
Need Assistance? Enter "Power" as the coupon code below.
Credit Card Payment: This form prompts you to pay via PayPal when you click submit. PayPal will open in a new window. You may pay with a credit card, a PayPal account is not required.
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Adult Membership
Adult Membership from Today until 9/30/2025
$
35.00
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