Lifetime Membership

Request a New Card

Why are you requesting a new lifetime membership card? *
Who are you? *
First Name *
Last Name *
Current Address *
Zip Code *
Birthdate
Current Email *
Phone Number

The following information is helpful if we have difficulty locating a record of your lifetime membership:

Previous Last Name(s) if applicable (maiden name, etc)
Address at the time of lifetime membership purchase (if available)
Previous Email used with Girl Scouts (if applicable)
Council affiliation at the time of lifetime membership purchase
Additional Details