Impact 100 Jersey Coast · 2023 Membership Pledge Form

New Member or Renewing/Returning Member?

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Update Information

I need to update my:

Address

Name

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First Name

Last Name

Email Address

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Preferred phone number

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Phone Type

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Mailing Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Mailing Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Birthday

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(mm/dd/yyyy)

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

Other (Member of another Impact, magazine article, social media, etc.)

Volunteer Interest

I am interested in hosting a member recruitment event.

Please share additional information about your background, experience, and/or volunteer interest:

Pledge Commitment

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I commit to become a Voting Member of Impact 100 Jersey Coast by making a tax-deductible donation of $1,100. ($1,000 for grantmaking; $100 will cover membership activities and CFNJ* fund management fee).

Planned Donation Method

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Check

Credit Card

Donor Advised Fund/Private Foundation

Employer is sponsoring

Applying for a scholarship

Other (Gifted membership, etc)

Please provide additional details about your gift (name of your Brokerage/DAF/Private Foundation, Name of Employer, Business or other individual making donation on your behalf.)

Planned Timing of Donation

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The Membership Team will invoice you on this date. In order to have voting rights at the 2023 Annual Meeting, your nonrefundable membership contribution must be received by March 15, 2023.

Eligible for Match?

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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

Do you have any details about your expected match or need additional assistance?

Demographic Information

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

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

*The Community Foundation of New Jersey is a nonprofit 501(c)(3) public charity, and all contributions are tax-deductible to the fullest extent of the law.

Pledge your donation for 2023 Membership