Membership Years of Service Pin

Complete this form and click the submit button on the bottom to Recognitions@GSEIWI.org. You can also give to your local Recognition Coordinator or mail to:

ATTN: Council Recognition Committee,
Girl Scouts of Eastern Iowa and Western Illinois,
2011 Second Avenue,
Rock Island, IL, 61201.

All orders must be received by the council by March 1.

Volunteer Membership Years of Service Pins indicate total girl and adult years in Girl Scouting. Pins are available in 5-year intervals. All pins are awarded by the Service Unit or individual and may be awarded at a local event.

** Means manditory information- you must fill in that field.
Date Service Unit #

**(if box is checked- must fill in fields with **)

Pins will be picked up by: (payment is expected when order is picked up)
Leadership Centers
Name
Phone
Date Select Date
Time
Location

**(if box is checked- must fill in fields with **)

Mail pins to: (must be prepaid- contact your local office)
Leadership Centers
Name
Address
City, State
Zip
Phone

Please allow 10 working days for processing.

Five Year Pins

1.
2.
3.
4.
5.
6.
7.
8.

Ten Year Pins

1.
2.
3.
4.
5.
6.
7.
8.

Fifteen Year Pins

1.
2.
3.
4.
5.

Twenty Year Pins

1.
2.
3.
4.
5.

Twenty Five Year Pins

1.
2.
3.
4.
5.

Thirty Year Pins

1.
2.
3.
4.
5.

Thirty Five Year Pins

1.
2.
3.
4.
5.

Forty Year Pins

1.
2.
3.
4.
5.

Forty Five Year Pins

1.
2.
3.

Fifty Year Pins +(indicate years)

1.
2.
3.

If you would like to print or save a copy for yourself, you must do so before submitting.
Click on the printer icon on the top right of your webpage to print or go to file and save as.

Press the submit button to email your membership years of service document.
Please review your information before submitting.