On Site Portal Payment for New Memberships

On Site Portal Payment for New Memberships
Please complete a separate form for each girl membership you are purchasing.
Parent/Guardian Name*

First Name/Nombre de AdultoLast Name/Apellido de Adulto
Date of Birth (Adult)*

MonthDayYear
Fecha de nacimiento (adulto)
Email (Adult)*
Correo electrónico (example@example.com)
Phone Number*
Numero de telefono. Format: (000) 000-0000.
Address/Dirreccion *

Street Address/Dirección

Street Address Line 2/Dirección (continuacion)

City/ciudadState / Province/estado

Postal / Zip Code/código postal
Are you signing up to be a Troop Leader?/¿Quieres ser lider de tu tropa?
Troop Number (if known)
Numero de tropa (si lo sabes)
Girl Name*

First Name/Nombre de niña Last Name/Apellido de niña
Date of Birth (Girl)*

MonthDayYear
Fecha de nacimiento de Niña
Name of School
Nombre de Escuela
School Grade *
Grado escolar
Please note that the prices on this form reflect the totals after the Bridge to Membership Fund promo codes.
I would like to opt out of using BTMF*

My Products

Girl Scout MY27 (orginal price $65)

Girl Membership (October 1, 2026 - September 30, 2027)

$45.00 Quantity

Adult MY27 (Original Price $30)

Adult Membership (October 1, 2026 - September 30, 2027)

$25.00 Quantity

Girl Scout EY27 (Original Price $91)

Girl Membership (April 1, 2026-September 30, 2027)

$71.00 Quantity

Adult MY27 (Original Price $42)

Adult Membership (April 1, 2026-September 30, 2027)

$37.00 Quantity

Total

$0.00

Please complete a separate form for each girl membership you are purchasing.