2024 Membership Form Installments by Credit Card

To join for 2024 please complete the form below allowing you to pay in installments by CREDIT CARD. Your $1,000 membership contribution goes in total to funding the grant. 110% Member 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. All installment credit card payments include a $34 processing fee. Please contact treasurer@impact100greaterchesapeake.org if you would like to pay in installments via check.

Contact Information

Name

First Name

Last Name

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Phone

Member Type

First Time Member

Renewing Member: You were a member last year

Rejoining Member: You were a previous member but not last year

Monthly Amount (4 installments)

$283.50 - 110% Member, with $1,000 going in full to the grant and $100 going to Impact Greater Chesapeake essential operating expenses. All credit card payments include $34 to cover card fees.

$258.50 - Member, with $1,000 going in full to the grant. All credit card payments include $34 to cover card fees.

Installment Schedule (ends after 4th payment)

I would like to make a contribution in addition to my membership

Yes

Contribution Type

To help with administrative costs

In honor of

In memory of

In Honor Of/In Memory Of Name

I agree to be listed in annual report documents as a donor.

Yes

Photo Release

I grant to IMPACT 100 Greater Chesapeake, and its representative, permission to publish in print, electronic, or video format my likeness or image. I release all claims against IMPACT 100 Greater Chesapeake with respect to copyright ownership and publications including any claim for compensation related to use of materials.

Yes