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Membership Anniversary Recognition Request
The Membership Anniversary Recognition celebrates the total years of Girl Scout membership (girl and adult membership combined) an individual has held in any Girl Scout council, at five year intervals (5, 10, 15, etc.). Girl Scout adults who have reached milestones in membership of 20 years or more (20, 25, 30, 35, etc.) will be presented with a pin at the council’s annual recognition event. Adults who have been members for 5, 10, and 15 years will receive mention at the council’s recognition event and a certificate. Individuals being recognized must hold a current Girl Scout membership.
For whom are you submitting this form?
*
Myself
My Service Unit/Group
Service Unit
Please select
I don't know
4 Stars - Barre, Hardwick, Oakham, New Braintree
Agawam
Amherst Area - Amherst, Leverett, Shutesbury, Pelham
Apple Blossom - Bolton
Apple Blossom - Harvard
A Valley UNiteD - Douglas, Northbridge, Uxbridge
Belchertown
Berkshire Marion White - Pittsfield, Richmond, Hancock, Lenox, Lee
Chicopee
City by the River - Fitchburg
East Longmeadow
Four Rivers - Rowe, Charlemont, Hawley, Plainfield, Ashfield, Buckland, Heath, Colrain, Shelburne, Leyden, Greenfield, Gill, Montague, Bernardston, Northfield, Erving
Frontier - Deerfield, South Deerfield, Sunderland, Conway, Whately
Furniture Loop - Gardner, Templeton, Phillipston, Hubbardston
Grafton Lakes
Greylock Girls - North Adams, Adams, Cheshire, Savoy, Clarksburg, Florida
Shooting Stars - South Hadley, Granby
Hadley
Hammerock - Charlton, Southbridge
Nonotuck-Williamsburg, Haydenville, Goshen, Chesterfield, Worthington, Northampton, Leeds, Florence, Hatfield
Historic Hopedale - Hopedale
Holden Greenways
Holyoke
Leominster Appleseeds
Longmeadow
Ludlow
Lunenburg Buttonwoods
Milford
Mills and Hills - Wales, Holland, Brimfield, Sturbridge, Warren, Brookfield
Monson
MUGS - Mendon, Upton
Nashua Clan - Clinton, Lancaster
North Quabbin - Athol, Orange, Wendell, New Salem, Warwick, Petersham, Royalston
Northborough
O. N. E. - Williamstown, New Ashford, Lanesboro
P.S. Wachusett - Princeton
P.S. Wachusett - Sterling
Pepperell
Pine Hill - Rutland, Paxton
Reservoir - Berlin, Boylston, West Boylston
Shrewsbury
Silver and Gold Belles - Worcester
Singletary - Millbury
Singletary - Sutton
South County Chickletts- Great Barrington, Otis, Alford, Egremont, Monterey, Sheffield, Mt. Washington, New Marlboro, Sandisfield, West Stockbridge, Stockbridge, Tyringham
Southern Tri-Towns - Southwick, Granville, Tolland
Springfield
Squannacook - Townsend, Ashby
Strawberry Hills - Leicester, Spencer, North Brookfield, East Brookfield, West Brookfield
Swift River - Palmer, Ware
The 100th Town - Westborough
The French Quarter - Auburn, Dudley, Oxford, Webster
The Gateway Girls - Huntington, Blandford, Russell, Montgomery, Middlefield, Chester
The Hamptons - Easthampton, Southampton, Westhampton
The Mountaineers - Becket, Dalton, Hinsdale, Peru, Washington, Windsor, Cummington
Westfield
West Springfield
Wilbrahampden-Wilbraham, Hampden
WWAGS - Ashburnham, Westminster, Winchendon
Contact Person's Name
Contact Person's
E-mail Address
# of Honorees
Please select
1
2
3
4
5
6
7
8
9
10
Honoree Information
(1) Honoree Name
(1) Current volunteer or community position:
(1) Total # of
Girl Scout Years
(girl + adult years)
(2) Honoree Name
(2) Current volunteer or community position:
(2) Total # of
Girl Scout Years
(girl + adult years)
(3) Honoree Name
(3) Current volunteer or community position:
(3) Total # of
Girl Scout Years
(girl + adult years)
(4) Honoree Name
(4) Current volunteer or community position:
(4) Total # of
Girl Scout Years
(girl + adult years)
(5) Honoree Name
(5) Current volunteer or community position:
(5) Total # of
Girl Scout Years
(girl + adult years)
(6) Honoree Name
(6) Current volunteer or community position:
(6) Total # of
Girl Scout Years
(girl + adult years)
(7) Honoree Name
(7) Current volunteer or community position:
(7) Total # of
Girl Scout Years
(girl + adult years)
(8) Honoree Name
(8) Current volunteer or community position:
(8) Total # of
Girl Scout Years
(girl + adult years)
(9) Honoree Name
(9) Current volunteer or community position:
(9) Total # of
Girl Scout Years
(girl + adult years)
(10) Honoree Name
(10) Current volunteer or community position:
(10) Total # of
Girl Scout Years
(girl + adult years)
Your Name
First
Last
E-mail Address
Your current volunteer or community position:
# of Years as a
Girl Member
# of Years as an
Adult Girl Scout
Total # of Girl Scout Years
(girl years + adult years)
Does the total equal more than 20?
Yes
No
Is THIS TOTAL a multiple of 5 (e.g. 20, 25, 30, etc)?
Yes
No
Please share a favorite memory of yourself as a Girl Scout, or a Girl Scout adult.