GIRL SCOUT MISSION Adult Membership Girl Scouting builds girls of courage, Join the global network of 2.5 million Girl confidence, and character, who Scouts Membership year through 9/30/2021 make the world a better place. Register online today at JoinGirlScoutsATL.com! MEMBERSHIP OPTIONS Annual Membership Check one: � New Member � Renewing Member � Lifetime Member � Troop # � Annual fee: $25 Title or salutation: � Mrs. � Ms. � Miss � Mr. � Dr. � Other: Lifetime Membership � One-time fee of $400 Adult 18 years or older who is not a former Name: First Middle Last girl member or former girl member who is 30 years or older. Address Apartment Young Alumnae Lifetime Membership City State Zip Code � One-time fee of $200 () () Former girl member who is 18-29 years old. Home Phone Business Phone New Members Only ( ) � Extended year: $35 Cell Phone Email Address Available for purchase between May 1 CONTACT INFORMATION CONTACT and September 30, 2020. Membership Employer Title/Occupation will be valid until September 30, 2021. I wish to opt in: �Texts YES! I would also like to make a � Emails By signing here and checking the circle to the left, each signee (and on behalf of the girl, as applicable) agrees to receive auto dialed informational or marketing text messages at the cell donation today that directly number above, understanding such consent is not required to join. benefits girls in our area. Enclosed is my tax-deductible donation. Girl Scouts respects and welcomes Gender: Number of years in Date of birth: Check one: people from all backgrounds � Female Girl Scouting: / / mm dd yyyy � $500 � $250 � $150 and abilities. By completing the � Male As a girl: following information (as defined by � $100 � $50 � $25 the U.S. Census Bureau), you ensure As an adult: support and funding for girls in I am (Check all that apply): I am Hispanic or Latina: � Other: $ your community. Hispanic/Latina � American Indian � White � Yes PAYMENT INFORMATION is defined as an ethnicity, not a or Alaskan Native � Other (Please specify) � No DEMOGRAPHICS race, therefore reported separately. � Asian � I choose not to share Annual Membership: $ This information is used for � Black or African American � I choose not to share at this time. Lifetime Membership: $ statistical purposes only. � Hawaiian or Pacific Islander at this time. Young Alumnae I will be participating in Girl Scouting as As a volunteer, I would like to participate in the Lifetime Membership: $ (Check all that apply): following role(s): Extended Year Fee: $ � Volunteer —I am/will be volunteering for Girl Scouts. � Advisor or leader for a group/troop � Parent/family —I am a parent/guardian/family member of a Girl Scout. � Assistant advisor Donation: $ � Girl Scout alumna —I was a Girl Scout, either as a girl, adult, or both. � Leader for a group/troop advisor/leader Total Attached: $ � Staff—I am/will be employed by Girl Scouts. � Support volunteer for a group/troop � Cash � Check* PARTICIPATION � Community partner � Service team or unit volunteer � Amex � Discover � Other � Learning facilitator � Visa � MasterCard � Other (specify) � Other Media Permission The Girl Scout Promise The Girl Scout Law When participating in Girl Scout activities, I (or the On my honor, I will try: I will do my best to be person I am registering) give consent to be inter- To serve God and my country, honest and fair, Name on Credit Card viewed, photographed, videotaped, or electronically To help people at all times, friendly and helpful, imaged for the purposes of promotional materials, And to live by the Girl Scout Law. considerate and caring, Credit Card # news releases, or other published formats for either courageous and strong, and the local Girl Scout council or Girl Scouts of the USA. When making the Girl Scout Promise, responsible for what I say and do, The images will be the sole property of the local Girl individual members may substitute and to Expiration Date CVV Code Scout council or Girl Scouts of the USA. I hereby wording appropriate to their own spiritual respect myself and others, release and hold harmless the local Girl Scout council beliefs for the word “God.” respect authority, Signature and Girl Scouts of the USA from any claim arising from use resources wisely, the use of these images. make the world a better place, and ACCEPTANCE be a sister to every Girl Scout. Date � I wish to opt out at this time. *Make checks payable to Girl Scouts. Return this registration form, along with the applicable GSUSA membership fee, to I accept and abide by the Girl Scout Promise and Law: your local council. Fees are not refundable or transferable to another person. Signature Date THANK YOU FOR SUPPORTING GIRL SCOUTS! Learn more about Girl Scouts at Council Code: Service Unit/Team: Group: USE www.GirlScoutsATL.org. ADMIN .