Annual Membership
$1,000 annual membership provides voting rights for one woman.
Membership
Membership Type
New Member
Returning Member
Amount
$1,000 for my one year membership
$1,100 for membership plus $100 for expenses*. 110% club!
* expenses associated with responsible administration of membership, communications, finances, accounting, and social events, which are subsidized from our operating funds
Contact Information
First Name
Last Name
Employer
Address
Address 2
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State/Province
Alabama
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Armed Forces Other
Armed Forces Pacific
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Zip/Postal Code
Phone
Email
Your entry is not a valid email address!
Who did you hear about Impact100OC from?
Volunteering Information
I am interested in volunteering in the following areas
(MUST SELECT AT LEAST ONE BUT NO MORE THAN THREE):
Grant Review - Evaluate grant applications, conduct site reviews and select finalists.
Events - Help plan and execute our events.
Communications - Create and distribute content for our website, social channels and emails.
Nonprofit Outreach - Grow our network of nonprofits and educate them on our grant process.
Financial Review - Analyze applicants' financial information as part of the grant review process.
One And Done - Assist our various committees on specific, one time tasks or projects.
Donate & Vote - I’m excited about the mission but don’t have extra time to volunteer
Evergreen Member
Do you want to express your continued commitment to Impact100 Oakland County by becoming an Evergreen Member and acknowledging your plan to enroll for future years? Evergreen members allow us to plan by knowing the number of recurring members we can count on each year. Evergreen members are designated in the member directory and have a special name tag. To become an Evergreen Member, you only need to make this pledge once. If your circumstances change in the future, simply let us know.
Evergreen Member
Help Us Cover Costs
Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.
Yes! I want $0.00 to go to Impact100 Oakland County and I will donate $0.00.
No. I will donate $0.00 and Impact100 Oakland County will cover the processing costs.
Payment Information
Payment Options
Credit Card
Bank Account
Credit Card Information
Card Holder Name
Visa
MasterCard
Discover
Amex
Card Account Number
Expiration Date
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
24
25
26
27
28
29
30
31
32
33
34
Security Code
Billing Address
Same As Above
Address
City
State/Province
Alabama
Alaska
Alberta
Arizona
Arkansas
Armed Forces Americas
Armed Forces Other
Armed Forces Pacific
British Columbia
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland & Labrador
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
Yukon
Zip/Postal Code
Email
Your entry is not a valid email address!
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