100 Women Who Care Antrim County Communities Membership Form

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I am pledging to participate and make a personal commitment to 100 Women Who Care - Antrim County Communities by agreeing to contribute $200 each calendar year ($100 in June $100 in October) to local nonprofit organizations serving Antrim County and surrounding areas. I agree to donate to the nonprofit organization selected by the group's majority vote at each meeting. If I am unable to attend a meeting, I will follow the groups' established procedures for voting and submitting my donation.

I 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 - Antrim County Communities.

I understand my personal contact information is strictly confidential and will only be used for internal communication. It will not be shared or distributed to an outside third party without my expressed consent.

Email *

First Name *

Last Name *

Email *

Street Address *

City *

State *

Zip Code *

Phone Number *

Would you like text messaging? Enter your phone number below if yes. *

I understand that I will write my check directly to the charity or nonprofit if I don't use Grapevine to donate directly *

Yes

Required

Electronic Signature *

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

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