Impact 100 Jersey Coast · 2023 Membership Form

Join and make your donation for 2023 Membership

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

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

Want to donate monthly? Join and begin installments.

Update Information

I need to update my:

Address

Name

First Name

Last Name

Email Address

Verify Email

Preferred phone number

Mailing Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Mailing Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

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.

Third Party Donor

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

Yes

Name of Third Party

If you have committed to be Evergreen and want your donation to automatically process to your credit card on this date annually, please select "Yearly" in the drop down box below.

Amount

$1,140 - Membership Donation

Please choose yearly if you want to be Evergreen and have your donation process automatically. You can end recurring payments at any time by emailing membershipops@impact100jc.org

Your donation of $1140 ($1,000 for grantmaking; $140 will cover membership activities, CFNJ* fund management fee and processing fees) will be processed today.

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.

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. Both my employer and my partner's employer.

Yes. My employer.

Yes. My partner's employer.

No.

Unsure, please send me information.

Name of Employer

Partner's Name

Partner's Employer

New members are critical to our success, whom 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 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.