Membership Enrollment Form

Current Members are encouraged to join and donate by December 31, 2025.
New Members will be accepted through July 1, 2026.
Membership Enrollments received after July 1, 2026 will become voting members for the 2027 Grant Awards.

First Name*

Last Name*

Sponsoring Member*

If someone else is funding your membership, please enter their name here.

Sponsoring Member Email*

Please enter their email here:

Mobile Phone*

Email*

MEMBERSHIP DONATION
Annual donation to Impact100 East Bay is $1000. 100% of the first $1,000 of every donation will be donated to fund Impact100 East Bay Grants.
Donations above $1,000 are deeply appreciated and will help us expand our impact by funding additional grants and supporting essential operating expenses.

Donation Amount*

Please enter your full donation amount. The minimum donation is $1,000. Additional donations are appreciated.

Please list the area(s) which grab your interest:*

Grants, Membership, Events, Technology, Communications/Social Media, Finance, Board Representative or anything else you can help out with.

If a member referred you, please include her name here:

Company Matching

If your company matches charitable donations, please list the company name here. You will receive an enrollment receipt you after your payment that you may submit to your Company Matching Funds administrator for processing.

Comments or Questions?

By submitting below, I am allowing Impact100 East Bay to use my name and image in photographic, audiovisual, and written works. To withdraw this consent please send a message to info@impact100eastbay.org with your request.

Other - Please explain

Make checks payable to IMPACT100 EAST BAY.
Please submit this form online and mail your check to:

IMPACT100 EAST BAY
Common Point NonProfit Center
164 North L Street
Livermore, CA 94550

Please submit your donation acknowledgement and instructions to your DAF administrator.
To ensure we can properly identify your donation, please include your name on the transmittal letter from your Donor Advised Fund

DAF Name:*

(eg Schwab DAF, Morgan Stanley GIFT, etc).

The treasurer will reach out to you with to discuss.
(JD - How do we want to work this? We want them to submit the form - do you want more information from them? Or to have them contact you? The latter seems like big ask.

Key Dates for 2026 Grant Cycle: