Impact 100 Jersey Coast · 2024 Membership 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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Verify Email

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Preferred phone number

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Phone Type

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By providing a mobile number you are authorizing Impact 100 Jersey Coast to send reminders via text messaging.

Mailing Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Update Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Evergreen

Become an Evergreen member by committing to renew your membership every year. Evergreen members allow us to plan by knowing the number of recurring members we can count on each year.

If you elect to have your membership auto-renew you are considered Evergreen.

If you don't want to have your membership auto-renew or you prefer to pay by check or third-party transfer, you can indicate your committment to be Evergreen by checking the Evergreen box below your donation selection. In subsequent membership years you will be considered a renewed member and we will send you an invoice so that you may make your donation.

Amount

$1,140 - Membership Donation by Credit Card for 2024

$1,140 - Auto-Renew Membership Donation by Credit Card- Evergreen Membership

$285 - Monthly Installments for 2024

$285 - Auto-Renew Monthly Installments- Evergreen Membership

$0 - Donation by Check or Third Party Transfer by March 15

Please do not modify this field.

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.

Evergreen

Yes, I'm Evergreen and commit to renewing my Impact 100 membership.

Evergreen

Yes, I'm Evergreen and commit to renewing my Impact 100 membership.

Annual Auto-Renew Acknowledgement

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You have chosen to auto-renew your membership annually. In order to ease the burden on our volunteers, we ask that you choose one of two dates for your donation in subsequent years. I understand that if I wish to discontinue , I will email membership@impact100jerseycoast.org

I understand that I have elected to have my donation auto-renew annually.

Annual Auto-Renew

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You have chosen to auto-renew your membership annually. In order to ease the burden on our volunteers, we ask that you choose one of two dates for your donation in subsequent years. I understand that if I wish to discontinue , I will email membership@impact100jerseycoast.org

November 30 of each year (We will waive credit card fees if you choose this option and your donation will be $1100)

March 1 (Donation will be $1140, which includes processing fees)

Monthly Auto-Renew

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You have chosen to auto-renew your membership monthly. In order to ease the burden on our volunteers, your donation will be processed on the 1st of the month in subsequent years. I understand that if I wish to discontinue , I will email membership@impact100jerseycoast.org

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 April 1, 2024.

Third Party Donor

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

Yes

No

Name of Third Party

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. 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 would like to continue in my current volunteer role.

I am interested in hosting a membership recruiting event.

I would like to join a committee.

I am interested in a leadership role.

I would be interested in one-time volunteer opportunities.

I cannot volunteer this year.

Which committee(s) are you interested in joining?

Review Grant Applications on a Grant Review Committee

Membership

Grants

Volunteers

Diversity & Inclusion

Finance

Operations

Marketing

Demographic Information

Birthday

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(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

NOT Hispanic or Latino

Code of Conduct, Confidentiality Agreement & Photo Release

I have reviewed the Code of Conduct on the Impact 100 Jersey Coast website. 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@impact100jc.org

Terms of Agreement

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

Accessibility Accommodations

Impact 100 Jersey Coast is fully committed to providing equal access for all of its members, volunteers, event attendees, and the public. Upon request, Impact 100 JC will make the necessary accommodations to allow individuals with special needs to participate in events/activities to the fullest extent possible. If you have a request or accommodation, or have questions, please contact us at ops@impact100jc.org.

Join us now for 2024 Membership

Demographic Information

Code of Conduct, Confidentiality Agreement & Photo Release