Membership Application 2026 Test

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*

Member Type*

First time Member

Renewing Member: I have previously been a Member

Sponsored Member: My membership is being funded by another member

Scholarship:

Scholarship Type

Young Philanthropist

Member Match

Sponsoring Member*

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

Sponsoring Member Email*

Please enter their email here:

Address*

Street Address Address Line 2 City State ZIP Code

Mobile Phone*

Text Permission*

May we text you periodically?

Yes

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.

Perpetual Impact*

I am interested in having my membership renew automatically each year. (Note: for Credit Card Donations you will be automatically charged every 12 months until you cancel.)

Yes

JD: Need to discuss how the process works from the CC processing end. How will people cancel??

Volunteer Opportunities*

This is a volunteer driven organization. We strongly encourage each and every member to participate in some way. Give as much as you choose. Most vary from 10-20 hours per year.

Yes

Not at this time

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.

Member Directory*

May we include your name, email, city, and phone number in our member directory? This information will only be used within Impact100 East Bay for other members to contact each other regarding Impact100 East Bay. It will not be used for solicitations.

Yes

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.

Payment Method*

Please select your payment method.

Other Payment Method*

Please select your payment method. The treasurer will reach out to you to arrange.

Installment

Stock Transfer

Become a Member – 2026 Test