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Impact100 DC Membership Directory Permission

We are planning to produce a directory of Impact100 DC members that would be for the exclusive use of our members, and not to be used for commercial or solicitation purposes.

The following information from our membership database will be listed for each member who opts in: (1) name, (2) home address, (3) email address, (4) phone number.

Name

First Name

Last Name

Opt In or Opt Out

Please include me in the membership directory.

Please do not include me in the membership directory.

Photo Permission

Please include my photo in the membership directory.

Please do not include my photo in the membership directory.

Providing Your Photo

If you have previously provided a photo to the Impact100 DC membership team, you are all set! Simply click "submit" below.

If you have not provided a photo or would like to provide a new one, please (1) complete this form by clicking "submit" below; and (2) email your photo to membership@impact100dc.org or to anyone on the Impact100 DC Board.