Volunteer Pin Application

Girl Scouts-Wilderness Road Council
2277 Executive Drive
Lexington, Kentucky 40505-4807
859-293-2621 * 800-475-2621

GIRL SCOUT MEMBERSHIP PIN GUARD

GIRL SCOUT VOLUNTEER PIN APPLICATION

Name:

Telephone: Email:

Address:

City: , State Zip:

Cluster:

Service Unit:

Girl Scout Positions Held:

First registered in (year) in Council.

Registered years as a girl.

Registered years as an adult.

Total years:

Membership Pin Guard: Girl and Adult years as a registered member apply toward the Membership Pin Guard. The years do not have to be consecutive.

Volunteer Pin: Adult volunteer years as a registered Girl Scout adult volunteer apply to the Volunteer Pin. The years do not have to be consecutive.

I AM APPLYING FOR:

MEMBERSHIP PIN GUARD VOLUNTEER PIN

5 Year Membership Pin Guard

5 Year Volunteer Pin

10 Year Membership Pin Guard

10 Year Volunteer Pin

15 Year Membership Pin Guard

15 Year Volunteer Pin

20 Year Membership Pin Guard

20 Year Volunteer Pin

Other:Year Membership Pin Guard

Other:Year Volunteer Pin

(available in increments of 5 years)

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