Membership Application

Membership applications for the 2023 voting year will close on Feb. 28, 2023. Applications recieved after this time will become members in 2024 and will not vote until the 2024 grant cycle.

"*" indicates required fields

First Name*

Last Name*

Position / Expertise

Email*

Phone*

Address*

Street Address City State ZIP / Postal Code

Membership*

I wish to make an additional contribution to help this organization thrive:

Additional Contribution Amount

We accept credit cards. There will be a $30 charge when you use your card to cover fees.*

I wish to pay by credit card and agree to this fee

I would like to pay by Zelle

I would like to pay by check

Please invoice me

Please complete this form and submit it online. You can mail your check to:
Impact100 Greater Sacramento, PO Box 711
Carmichael, CA 95609

Please complete this form and submit it online. We will send you an invoice.

Please complete this form and submit it online. Our email for Zelle payments is:
Impact100GreaterSacramento@gmail.com

Donation Total

Credit Card

Card Details

Cardholder Name

I know someone who is interested in providing a sponsorship, hosting or donating to an event.

Yes

Not at the moment

This is a volunteer driven organization. We strongly encourage each and every member to participate in some way. Please check which area(s) grab your interest.

Health and Wellness Focus Team

Environment Focus Team

Special Events Team

Education Focus Team

Membership Team

Scholarship Team

Arts and Culture Focus Team

Fund Development Team

I am unsure – Circle back

Family Focus Team

Communication/PR Team

By signing below, I authorize Impact100 Greater Sacramento to publish my name and photo in promotional materials as well as on our website. Your name, phone, and email address will be displayed in our Membership Directory. Contributions are non-refundable and due before February 28, 2023. Checks are preferred. Please make them payable to Impact100 Greater Sacramento. Please mail to: Impact100 Greater Sacramento PO Box 711 Carmichael, CA 95609.

Signature

Date

MM slash DD slash YYYY

We are a 501(c)(3) – Tax ID #88-3110428

Thank you to our membership sponsor Willo Salons.

Email

This field is for validation purposes and should be left unchanged.