One moment please...
2022-23 Shared Membership - pay by paper check
  • Two women may form a Shared Membership.
  • Each Shared Membership is entitled to one vote in all voting procedures, including Focus Area Committee votes and the Final Grant Award vote at the annual meeting.
  • The contribution for a Shared Membership includes a $70 administrative/operational fee ($35 per person).
  • Each member should complete her own form and will receive a tax acknowledgement letter for her records.
  • The Shared Membership is official once both forms have been completed and the total $1,000 + $70 administrative fee has been paid.
Please make check in the amount of $535 (half of total $1,070 membership) payable to Impact100 DC. Mail your check to Impact100 DC, PO Box 40121, Washington, DC 20016
YOUR CONTACT INFORMATION
*

First Name
Last Name
*

*

*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

*
Are you a new or returning member of Impact100 DC?
SHARED MEMBERSHIP
Your $500 membership contribution goes in total to funding the grant. Shared memberships require an additional contribution of $70 ($35 per person) to help support operating costs.
*
CONTACT INFORMATION FOR SHARED MEMBER
*

First Name
Last Name
*

*

*
*
This directory is for the exclusive use of our members and is not to be used for commercial or solicitation purposes. It is housed in a password-protected area of our website under Membership.
I WOULD LIKE TO VOLUNTEER!

First Name
Last Name
*
Media Release: I hereby grant Impact100 DC, and its respective agents and assigns, the unrestricted right to use images of me from Impact100 DC events (both live and virtual) for trade, marketing, and other purposes without restriction and without my inspection or approval. I hereby release Impact100 DC and its respective agents from any legal claims or financial liability associated with such use. Do you agree to this waiver?
Mail check to:

 Impact100 DC, PO Box 40121, Washington, DC 20016