Membership Request | GSGLA volunteer

Wildfire Assistance

Were you impacted by the wildfires?*
- Yes
- No
Contact Information

For which are you registering?*
- Adult
- Girl
Is the girl member age 13 or older*
- Yes
- No
Membership Type:*
- New Member
- Renewing Member
- Lifetime Member (Adult members only)
Membership Type:*
- New Member
- Renewing Member
Girl members cannot select a lifetime membership. Please select another membership type.
Adult/Girl Member Name*
First Last
Girl/Adult Member Address*
If your mailing address has changed, please provide a new address.

Street Address Address Line 2 City State ZIP Code
Girl/Adult Home Phone*
Business Phone
Cell Phone
Adult/Girl Email*
Enter Email Confirm Email
I wish to opt-in to the following:*
By opting-in to the communications below, you agree to receive auto dialed informational, marketing text messages, or marketing emails at the cell/email provided, understanding such consent is not required to join.
- Texts Only
- Emails Only
- Both Texts and Emails
- Niether
Employer Name
Position/Title
Troop Number*
If troop number is unknown, please enter 0.
Service Unit*
Parent/Guardian Information

Parent/Guardian Name*
First Last
Parent/Guardian Date of Birth*
Month
Day
Year
Relationship to Girl Member:*
- Mother/Female Guardian
- Father/Male Guardian
Parent/Guardian Member Address*
If your mailing address has changed, please provide a new address.

Same as girl address

Street Address Address Line 2 City State ZIP Code
Parent/Guardian Home Phone*
Business Phone
Cell Phone
Parent/Guardian Email*
Enter Email Confirm Email
I wish to opt-in to the following:*
By opting-in to the communications below, you agree to receive auto dialed informational, marketing text messages, or marketing emails at the cell/email provided, understanding such consent is not required to join.
- Texts Only
- Emails Only
- Both Texts and Emails
- Niether
Employer Name
Position/Title
Troop Number*
If troop number is unknown, please enter 0.
Service Unit*
Would you like to add another parent/guardian?*
- Yes
- Not at this time
Hidden
Additional Parent/Guardian Name*
First Last
Additional Parent/Guardian Date of Birth*
Month
Day
Year
Relationship to Girl Member:*
- Mother/Female Guardian
- Father/Male Guardian
Additional Parent/Guardian Member Address*
If your mailing address has changed, please provide a new address.

Same as girl address

Street Address Address Line 2 City State ZIP Code
Additional Parent/Guardian Home Phone*
Business Phone
Cell Phone
Additional Parent/Guardian Email*
Enter Email Confirm Email
I wish to opt-in to the following:*
By opting-in to the communications below, you agree to receive auto dialed informational, marketing text messages, or marketing emails at the cell/email provided, understanding such consent is not required to join.
- Texts Only
- Emails Only
- Both Texts and Emails
- Niether
Employer Name
Position/Title
Troop Number*
If troop number is unknown, please enter 0.
Service Unit*
Demographics

Girl Scouts respects and welcomes people from all backgrounds and abilities. By completing the following information (as defined by the U.S. Census Bureau), you ensure support and funding for girls in your community. Hispanic/Latina is defined as an ethnicity, not a race, therefore is reported separately. This information is used for statistical purposes only.
Gender*
- Female
- Male
- Prefer not to answer.
Registrant Date of Birth*
Month
Day
Year
Number of years in Girl Scouting as a girl:*
Number of years in Girl Scouting as an adult:*
Girl member current school grade level:*
Name of School*
Custodial Care*
- Both Parents
- Mother/Female Guardian Only
- Father/Male Guardian Only
I am/girl member is: (Select all that apply)*
- American Indian or Alaska Native
- Asian
- Black or African American
- Hawaiian or Pacific Islander
- White
- Other
- Choose not to share at this time.
Please describe:*
I am/girl member is Hispanic or Latino/Latina*
- Yes
- No
- Choose not to share at this time.
Participation
How will you be participating in Girl Scouts? (Select all that apply)*
- Community Partner
- Girl Scout alumna—I was a Girl Scout, either as a girl, adult, or both.
- Parent/family—I am a parent/guardian/family member of a Girl Scout.
- Staff—I am/will be employed by Girl Scouts.
- Volunteer—I am/will be volunteering for Girl Scouts.
- Other
Please describe:*
As a volunteer, I would like to participate in the following role(s): (Select all that apply)*
- Advisor or leader for a group/troop
- Assistant advisor
- Leader for a group/troop advisor/leader
- Learning facilitator
- Service team or unit volunteer
- Support volunteer for a group/troop
- Other
Please describe:*
Membership Information

Membership requests will be processed within five business days of submission. A confirmation of membership will be sent via email once the membership request has been processed. You may contact registration@girlscoutsla.org with any questions.
Please select a membership option:*
- Current Year Annual Membership (10/1/2024 through 9/30/2025) - $25
- Next Year Annual Membership (10/1/2025 through 9/30/2026) - $30
- New Member Extended Year (today— 9/30/2026) - $42
- Lifetime Membership (one-time fee) - $400
Please confirm your membership option:*
- Current Year Annual Membership (10/1/2024 through 9/30/2025) - $25
- Next Year Annual Membership (10/1/2025 through 9/30/2026) - $45
- New Member Extended Year (today— 9/30/2026) - $63
Method of Payment*
- Credit/Debit Card (To be charged within 5 business days.)
- Financial Aid
- Program Credit (Girl membership only)
Adult members cannot select a program credit. Please select another payment type.
Would you like to make a tax-deductible donation today that will directly benefit girls?*
- Yes
- Not at this time.
Donation Amount*
Total to be charged:*
Total to be charged:*
Credit Card Type*
- Amex
- Discover
- Visa
- MasterCard
Name on Card*
First Last
Number*
Expiration (MM/YY)*
CVV*
Name on Program Credit*
First Last
Acceptance and Permissions

Girl Scout Promise and Law*
By checking this box, I agree to uphold the Girl Scout Promise and Law.
Girl Scout Promise and Law*
By checking this box, I/We acknowledge that the registrant will accept and abide by the Girl Scout Promise and Law. The registrant has permission to join Girl Scouts.
MEDIA PERMISSION
When participating in Girl Scout activities, I (or the person I am registering) give consent to be inter- viewed, photographed, videotaped, or electronically imaged for the purposes of promotional materials, news releases, or other published formats for either the local Girl Scout council or Girl Scouts of the USA. The images will be the sole property of the local Girl Scout council or Girl Scouts of the USA. I hereby release and hold harmless the local Girl Scout council and Girl Scouts of the USA from any claim arising from the use of these images.
Please select one of the following:*
- I would like to grant media permission as described above.
- I would prefer to NOT grant media permission at this time.
SIGNATURE CONFIRMATION
By providing your electronic signature below, you acknowledge that this membership request will be processed after the system is back online, the week of Dec. 15. At that time, any credit card charges will be applied, and financial aid/program credit requests will be reviewed.
Signature
You may use your mouse to sign in the box by hovering over the box and holding down the left click button while drawing your signature. Or, if you are using a touch enabled device (e.g. iPhone, Android, tablet, etc...), you may sign with your finger or stylus.
CAPTCHA

Wildfire Assistance

Contact Information

Parent/Guardian Information

Demographics

Participation

Membership Information

Acceptance and Permissions