Registration & Commitment Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Commitment: By completing this form, I am agreeing that the information I provide below is accurate and true. I am pledging to participate in 100 Women Who Care Sudbury, and I am making a personal commitment to contribute $400 each calendar year ($200/meeting) to local nonprofit organizations serving the Northeastern Ontario region. I agree to donate to the nonprofit organization selected by the group’s majority vote. If I am unable to attend a meeting, I will either send my cheque with another attending member to deliver on my behalf, mail it as requested after the meeting, or pay online, if that option is presented. I also acknowledge that photographs and videos taken at events and meetings may include my image and may be used in promotional materials for 100 Women Who Care Sudbury.

Email *

Your Name *

Mailing Address *

Phone Number

I understand my personal contact information is strictly confidential and I understand it will not be shared or distributed to an outside third party without my expressed consent. If 100 Women Who Care Sudbury chooses to publish a Membership Directory, I agree that my contact information be included in that directory. *

Yes

Required

Questions and comments

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Dr. Jeffrey Shum Medicine Professional Corporation.

Does this form look suspicious? Report

Forms