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Membership Registration Form

Thank you for joining 100 Women Who Care Stouffville!

Please fill out the form below. This information is needed for planning purposes for the meetings and for receipts from the organizations that will receive the donations.

* Indicates required field

Are you: *

Signing up as an individual Signing up as a team (maximum 2 per team)

Name *

First

Last

Address *

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City

State

Zip Code

Country

Primary Phone Number *

Alternate Phone Number *

Email *

May we display your first & last name (or the name of your team, if applicable) on the 100 Women Who Care Stouffville website and Facebook page? *

Yes No

Only Complete if Signing Up as a Team:

Team Name *

How will the donation be split between members? *

If you are making a commitment as part of a team, each person should submit their own Membership Registration Form. All members can attend each meeting, but each team may only vote once and may only submit one charity for nomination at each meeting.

Terms and Conditions

I understand that I am making a commitment to 100 Women Who Care Stouffville to make an annual donation of $400 (individually or as a team combined) ($100 at each of the four meetings), which will be given directly to local charities, non-profits and organizations serving the Stouffville area.

I agree to fulfill my donation commitment even if I did not vote for the charity selected by majority vote.

If I am unable to attend a quarterly meeting, I will give my cheque to another member to deliver in my place or email stouffville100women@hotmail.com to arrange delivery.

By Participating today, you will be automatically added to receive communications from 100 Women Who Care.
You can change your account preferences at any time.

By clicking the Submit button below, I acknowledge acceptance of these terms and conditions.

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