Years of Membership Pin Request Form

Years of Membership Pin Request Form

Girl Scouts of Eastern Massachusetts is dedicated to honoring our long-term volunteers with Years of Membership Numeral Guard Pins. Volunteers celebrating their anniversary year of 20, 25, 30, 35, etc. may choose to join GSEMA staff and volunteers at our annual celebration event or request that a pin be mailed to them.

Volunteer Name:

First NameLast Name

Contact Email:

example@example.com

Contact Phone Number:

Area CodePhone Number

For whom are you submitting this form?

Person For Whom You Are Submitting:

First NameLast Name

Their Email

example@example.com

Their Phone Number

Area CodePhone Number

How many years of membership are you reporting for this volunteer?

Please include girl years and adult years, as well as the current membership year, in your total. We do not have a reliable way of verifying most records; please be as accurate as possible.

What was the last year of membership numeral pin received (if any)?

Examples: 5 year, 10 year, 15 year, 20 year, etc.

Membership Year Due

Current membership is 2025; if overdue, please let us know the year you SHOULD have received your pin so we can get you back on track for the future!

How would the volunteer like to receive their membership numeral pin?

Questions or problems? Email Customer Care at CustomerCare@gsema.org!