Impact100 DC · 2022-2023 Membership Form

CONTACT INFORMATION

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MEMBERSHIP OPTIONS

We hope that you will join as a Member Plus. With every penny of your $1,000 donation going to the grant, we rely on those generous additional contributions to defray critical operating costs.

Membership Level

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$1,100 - Member Plus - the additional $100 helps defray critical operating expenses

$1,000 - Member

Fellowship Program and/or Additional Support

Our Fellowship Program sponsors women for membership who would like to be actively involved but currently lack the financial capacity to join.

Additional support contributions, again, are very welcome and allow us to continue to make improvements in the systems we use for grant review, databases, and the like.

Fellowship Amount

$

Additional Support

$

TOTAL AMOUNT

ARE YOU A NEW OR RETURNING MEMBER OF IMPACT100 DC?

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New Member for 2022-23

Renewing Member

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Please click yes to receive our monthly newsletter and other important updates.

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Would you like to be included in the Impact DC membership directory?

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This directory is for the exclusive use of our members and is not to be used for commercial or solicitation purposes. It is housed in a password-protected area of our website under "Membership."

I WOULD LIKE TO VOLUNTEER!

I am interested in

Events

Communications

Membership

Technology (website, database management)

Finance

Grant Review Committees

How did you hear about Impact100 DC?

From a member of Impact100 DC

From a member of another Impact100 chapter

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Name of Referring Impact100 DC member

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WAIVERS

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Media Release: I hereby grant Impact100 DC, and its respective agents and assigns, the unrestricted right to use images of me from Impact100 DC events (both live and virtual) for trade, marketing, and other purposes without restriction and without my inspection or approval. I hereby release Impact100 DC and its respective agents from any legal claims or financial liability associated with such use. Do you agree to this waiver?

Yes

No