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2021-22 Membership Form - pay by eCheck

To join, please complete the form below allowing you to pay by electronic check.

CONTACT INFORMATION
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First Name
Last Name
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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.
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

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This directory will be for the exclusive use of our members and is not to be used for commercial or solicitation purposes.
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Providing your photo

If you have previously provided a photo to the Impact100 DC membership team, you are all set! 

If you have not provided a photo or would like to provide a new one, please email your photo to membership@impact100dc.org or to anyone on the Impact100 DC Board.

I WOULD LIKE TO VOLUNTEER!

First Name
Last Name
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