Form#1 - Registration & Commitment
Commitment: By submitting this form, I am agreeing that the information I provide is accurate and true. I am pledging to participate in 100 People Who Care Brant for a minimum of 3 donations over the period of one year, and I am making a personal commitment to contribute an amount between $75 and $300 (as specified below) each calendar year (i.e., $25 to $100, 3 times a year) to be donated directly to local charities as nominated by members, approved by the Steering Committee and selected by majority vote, on the understanding that all monies donated will serve residents of Brant, Brantford and Six Nations.

I will send my donation either to the Donations Coordinator (by cheque made payable to the selected charity) or to the CanadaHelps Fundraiser set up in support of the selected charity by the Steering Committee. I understand that I will receive tax receipts directly from the selected charity or CanadaHelps.

 I also acknowledge that photographs and videos taken at events may include my image and may be used in promotional materials for 100 People Who Care Brant.

I further agree that no personal or business related solicitations will be shared on the 100 People Who Care Brant social media and I agree that my comments and posts will be relevant to the interests of 100 People Who Care Brant.

I understand that my personal information will be kept confidential except for my full name, mailing address (as required by Revenue Canada) and email address which will be shared with the selected charity.

Note: Should you wish to discontinue membership at any time after your one year commitment (3 donations) please send an email to 100WhoCareBrant@gmail.com.

Revised November 6, 2024
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Email *
Is this a business or personal registration? *
Last Name (or Business Name) *
First Name (or Business Contact Name) *
Please provide any other name that you may use when making your donation (so we can connect your donation to your membership correctly)
Level of Commitment (Please make yourself a note of this so you will remember when it comes time to donate) *
If you selected 'Other' as your Level of Commitment, please specify the amount of your ANNUAL pledge (over $75) below
Street Address (where tax receipts will be sent) *
City *
Postal Code *
Phone Number *
Date *
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If 100 People Who Care Brant chooses to publish a membership directory, do you agree that your contact information as provided above can be included in that directory? *
Do you acknowledge that you have received, and are in agreement with, the 100 People Who Care Brant Agreement? (If you did not receive it, please email a request to 100WhoCareBrant@gmail.com before submitting this form) *
Please tell us how you learned about 100 People Who Care Brant *
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