Adult Membership Form

Adult Membership Form: Tell Us About You!

Girl Scout membership is good through 9/30/2025.
Already a member? Renew here.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
No mobile information will be shared with third parties/affiliates for marketing/promotional purposes.
E-mail*
example@example.com
Gender*
Birth Date*

MonthDayYear
Date
Ethnicity*
Race (Check all that apply.)*

American Indian or Alaskan NativeAsianBlack or African AmericanHawaiian or Pacific IslanderWhiteOther RacesI choose not to share.Staff Only - Family did not report race.
Were you a Girl Scout Daisy, Brownie or higher, it all counts?*

YesNo
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 and volunteers are at the heart of it all.
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.

Adult MembershipAdult Membership from Today until 9/30/2025

$25.00

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Total

$0.00

Name of Person Submitting Form*
By completing membership registration, I affirm that I understand and agree to adhere to Girl Scout Child Abuse Prevention policies and procedures.
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Adult Membership Form: Tell Us About You!

Power the Promise

Need Assistance? Enter "Power" as the coupon code below.