Adult Membership Form

Adult Membership Form: Tell Us About You!

Girl Scout membership is good through 9/30/2026.
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
Financial Assistance

Girl Scouts of Kentuckiana is dedicated to removing barriers and providing access to Girl Scout membership, and all financial assistance provided is made possible by our generous donors.
If the membership fee of $42 is out of reach, we want to help. Would you like to explore financial assistance?

No. I will join with the $42 fee.Yes. Show options for a reduced membership fee.
WHY: Financial circumstances shouldn’t prevent membership in Girl Scouts of Kentuckiana. Our local council can help lower your cost for the membership fee.

WHAT: We can help cover the membership fee through our generous donors. You pay what you’re able, and the remaining cost is supplemented by local donors who believe that every Girl Scout will benefit from a strong sense of self, develop positive values, seek challenges, build healthy relationships, and solve community problems.

HOW: We want to welcome you to Girl Scout! If you need, consider the private options below. To supplement the $42 membership fee, select the option below which describes your ability to pay. Your membership fee will be adjusted before you pay. We depend on the trust and honesty of our members as we use limited funds to offset these membership fees.
Option

I’m able to pay 75% –or $31.50– toward membership, and council donors cover the rest.I’m able to pay 50% –or $21.00– toward membership, and council donors cover the rest.I’m not able to pay toward Girl Scout membership, and 100% of the membership fee will be covered by donors.
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.
Membership Fee Calculation
Girl Scout Membership Fee Through 9/30/2026

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USDTotal Amount Due
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!

Financial Assistance