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Membership Application 2023 Test
Become a Member 2023 Test
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Member Type
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First time Member
Renewing Member: I have previously been a Member
Sponsored Member: I am being Sponsored by another Member
Sponsoring Member
If this member is sponsored, please enter the name of the sponsoring member here.
First Name
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Last Name
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Address
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Street Address
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City
State / Province / Region
ZIP / Postal Code
Email
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Phone
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Membership Level
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100% of the first $1,000 of every donation will be donated to fund Impact 100 East Bay Grants. Select one option below.
Member Champion ($1,500 or more) Your gift of $1,500 or more will help fund operational and/or scholarship funds.
Member Plus ($1,100 - $1,499) with amount in excess of $1,000 used to offset operating expenses of our all-volunteer organization.
Member ($1,000) 100% of this donation will be applied to the Impact Grant(s).
Member Champion Donation Option
*
$500 of my donation goes to the scholarship fund with any remaining to operating expenses
Use the funds where they are most needed
Enter Full Donation
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Please enter $1,000 if you are joining as a Member. If you are making an additional contribution as a Plus or Champion, please enter the full amount of your donation.
Auto renewal
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I am interested in having my membership renew automatically each year. Please have the treasurer contact me.
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I am interested in volunteering
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Yes
No
Member Directory
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We are developing a member directory to include name, email, and phone number contact. This information will only be used for other members to contact each other regarding Impact 100 East Bay. It will not be used for solicitations. May we included your name and contact information in this directory?
Yes
No
If a member referred you, please include her name here:
Company Matching
If your company matches charitable donations, please list the company name here and submit the enrollment receipt you will receive after your payment to your Company Matching Funds administrator for processing.
Comments
Please enter any additional information or comments on your experience.
By submitting below, I am allowing Impact 100 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.
Payment Method
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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
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Year
Year
2023
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Please note that a 3.5% convenience fee will be added to your donation when you pay by credit card.
eCheck
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Bank Name
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Checking
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Make checks payable to
IMPACT 100 EAST BAY.
Please submit this form online and mail your check to IMPACT 100 EAST BAY, PO Box 2889, Castro Valley, CA 94546-0889
Please submit your donation acknowledgement and instructions to your DAF administrator.
Our treasurer will contact you to establish a plan suitable to your needs.
