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2021-22 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
Address Line 1
Address Line 2
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.
$535 - Join as a Shared Member
CONTACT INFORMATION FOR SHARED MEMBER
Name of other person in your Shared Membership
Email address of other person in your Shared Membership
Would you like to be added to the Impact100 DC email list?
This will allow you to receive our monthly newsletter and other important Impact100 DC updates.
Would you like to be included in an Impact DC membership directory?
This directory will be for the exclusive use of our members and is not to be used for commercial or solicitation purposes.
I WOULD LIKE TO VOLUNTEER!
Contact me for help with:
Technology (website, database management)
Grant Review Committees
How did you hear about Impact100 DC?
From a member of Impact100 DC
From a member of another Impact100 chapter
Word of mouth
Name of the Impact100 DC member
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.
Mail check to:
Impact100 DC, PO Box 40121, Washington, DC 20016