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2022-2023 Membership Form - pay by credit card
PLEASE NOTE: PAYING BY CREDIT CARD INCLUDES AN ADDITIONAL 3% PROCESSING FEE.
CONTACT INFORMATION
Name
*
First Name
Last Name
Email
*
MEMBERSHIP OPTIONS
Your $1,000 membership contribution goes in total to funding the grant. Member Plus contributions of $1,100 as well as any additional amount you enter in the third, customized option are highly appreciated and help defray essential operating expenses in this all-volunteer organization.
Amount
*
$1,130
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Join as a Member Plus, with $1,000 going in full to the grant and $100 going to Impact DC essential operating expenses.
$1,030
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Join as a member
$
Are you a new or returning member of Impact100 DC?
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New Member for 2022-23
Renewing Member
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Please click yes to receive our monthly newsletter and other important updates.
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Would you like to be included in the Impact DC membership directory?
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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."
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I WOULD LIKE TO VOLUNTEER!
Contact me for help with:
Events
Communications
Membership
Technology (website, database management)
Finance
Grant Review Committees
How did you hear about Impact100 DC?
From a current Impact100 DC member
From another Impact100 chapter member
News article
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Name of 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
No
