Impact 100 Jersey Coast · DO NOT Archive - Old Installments Form still processing

Join and begin making installment donations for 2024 Membership

Please complete this form if you'd like to make your full donation in monthly installments using your credit card.

Want to donate in full today? Join and donate using your credit card in full today.

Want to pledge your donation and pay another way or at a later date? Pledge your donation.

If encounter any problems completing this form, please email membershipops@impact100jc.org

Update Information

I need to update my:

Address

Name

First Name

Last Name

Email Address

Verify Email

Preferred Phone Number

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Name on Credit Card/Third Party Donor

My business, employer, family foundation or other entity/individual is making this gift on my behalf.

Yes

Name of Third Party/Name on Credit Card

Amount

$190 - First Donation will be processed today

Your Membership Donation will be processed

Your first donation will be processed today.

Your subsequent donations will be processed automatically monthly until March 15, 2024 when your full member donation is fulfilled. $1000 of your total donation will be for grantmaking and the balance will cover membership activities, CFNJ fund management fee and processing fees.

Impact 100 Jersey Coast operates under The Community Foundation of New Jersey which is a nonprofit 501(c)(3) public charity, and all donations are tax-deductible to the fullest extent of the law.

Auto-Renew My Membership

For your convenience, we are offering an auto enrollment feature for future membership years that allows you to spread out the cost of your next year’s membership across 12 monthly donations. If you are not interested in the auto enrollment feature, simply check the second option to decline. You will still be able to re-enroll in the installment plan for the next membership year whenever you choose.

Yes, I wish to participate in the Impact Auto-enroll Program, and understand this will result in a charge to my credit card for 12 monthly installments of $95 for the 2025 membership year and each subsequent year, starting on March 16, 2024. I understand that if I wish to discontinue this feature, I will email membership@impact100jerseycoast.org.

No, Do NOT enroll me for future year installments.

Evergreen

*You commit to annually renewing your Impact 100 membership by checking the Evergreen Membership. Until you let us know otherwise, in coming years you will be considered a renewed member.

Yes, I'm Evergreen and commit to renewing my Impact 100 membership. (If you elected to auto-enroll in Installments for subsequent years, you are automatically considered Evergreen.)

Eligible for Match?

Our Matching Gifts Coordinator can help determine if funds are available through an employer's matching gift program and can help you initiate the process. All matching funds provide vital support to Impact.

Yes. My employer.

Yes. My partner's employer.

No.

I'm not sure.

Name of Employer

Partner's Name

Partner's Employer

New members are critical to our success, who should we thank for referring you to Impact 100 Jersey Coast?

First Name

Last Name

First Name

Last Name

First Name

Last Name

Please let us know if you learned about Impact 100 Jersey Coast from another source (member of another Impact, magazine article, social media, etc.)

Volunteer Interest

I just want to donate and vote this year.

I am interested in hosting a membership recruiting event.

I would like to join a committee.

Something else, please contact me.

Which committee(s) are you interested in joining?

Membership

Grants

Volunteers

DEI

Finance

Operations

Marketing

Demographic Information

Birthday

(mm/dd/yyyy)

Race

Select all that apply.

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian of Other Pacific Islander

White

Some Other Race

Ethnicity

Select One

Hispanic or Latino

NON Hispanic or Latino

Confidentiality Agreement & Photo Release

I will not disclose confidential information acquired in connection with the work I do on behalf of Impact Jersey Coast. I agree not to share members’ names outside the organization and understand that the membership list will be printed and distributed to other members. I agree that my image may be used in photographs to promote Impact Jersey Coast via its website, on social media, and in other materials. If you do not wish to be included in the listing, please email: membership@impact100jerseycoast.org.

Terms of Agreement

I have read and agree to all terms outlined in the Impact 100 Jersey Confidentiality Agreement.