New Member Commitment Form
Please fill out the form below to join 100+ Women Who Care Placer County.
Email address *
First Name *
Last Name *
Street Address *
You address will be provided to the nonprofits so they may send you a receipt for tax purposes.
City *
Zip *
Phone Number *
Commitment / Signature *
Please type your name and check below to indicate that you are committing to join 100+ Women Who Care Placer County.
Name for Website
If different from your name as entered above, please indicate how you would like to be listed on the website's public list of members and other forms of recognition. If you prefer not to be listed, please put "Anonymous". If you leave this field blank, we will list your name as indicated above.
How did you hear about us? *
If you heard about 100+ Women Placer from a friend. Please share with us who so we can thank them.
Privacy Information
We agree not to sell, give, rent, or in anyway share your personal information for any use other than to maintain our membership list, to contact members about 100+ Women Who Care Placer County, and to provide the nonprofit recipients information to provide tax receipts. The nonprofits likewise agree only use personal information to send tax receipts and agree that they will not solicit additional donations from our membership directly unless given permission by the member.
Photo Release
By submitting this commitment form I hereby grant 100+ Women Who Care Placer County permission to use my likeness in photographs and/or video in any and all of its publications, including Web space, and in any and all other media, whether now known or hereafter existing, controlled by 100+ Women Who Care Placer County, in perpetuity. I will make no monetary or other claim against 100+ Women Who Care Placer County for the use of the photographs and/or video.

We recognize our members on our website, via social media and other venues. If you are uncomfortable with that kind of attention, please let us know at

A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of 100+Woman Who Care Placer County. Report Abuse