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2025 Membership Form - pay by paper check

Please make check payable to Impact100 DC. Mail your check to Impact100 DC, PO Box 40121, Washington, DC 20016

CONTACT INFORMATION

Name

First Name

Last Name

Verify Email

Address

Address Line 1

Address Line 2

City

State

State/Province

ZIP/Postal Code

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Preferred phone

MEMBERSHIP OPTIONS

We hope that you will join as a Member Plus. With every penny of your $1,000 donation going to the grant, we rely on those generous additional contributions to defray critical operating costs.

Select Membership Level

1100 - Member Plus to help cover operating expenses

1000 - Member

Fellowship Program and/or Additional Support

Our Fellowship Program sponsors women for membership who would like to be actively involved but currently lack the financial capacity to join.

Additional support contributions, again, are very welcome and allow us to continue to make improvements in the systems we use for grant review, databases, and the like.

Fellowship amount

Additional Operating Support

Please click yes to receive our monthly newsletter and other important updates.

Would you like to be included in the Impact DC membership Directory?

This directory is housed in a password protected area of the Impact100 DC website. It is for the exclusive use of our members and is not to be used for commercial or solicitation purposes.

I WOULD LIKE TO VOLUNTEER!

I am interested in being involved with:

Events

Communications

Membership

Technology (website, database management)

Finance

Grant Review Committee

How did you hear about Impact100 DC?

From a member of Impact100 DC

From a member of another Impact100 chapter

News article

Social media

Word of mouth

Name of Referring Impact100 DC member:

First Name

Last Name

WAIVERS

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?

Yes

Mail check to:

Impact100 DC, PO Box 40121, Washington, DC 20016