Membership Form
Please fill out the form below to join 100+ Women Stong Inland Mendo. For more information, please visit our website at 100strongmendo.com
Email address *
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number
Your answer
Pledge *
I agree that the information I provide below is accurate and true. I am pledging to participate in 100+ Women Strong Inland Mendo and I am making a personal commitment to contribute $400 each calendar year ($100 quarterly) to local nonprofit organizations serving Mendocino County.
Required
Donation *
I agree to donate each quarter to the nonprofit organization selected by the group’s majority vote. If I am unable to attend a quarterly meeting, I will mail my check made payable to the winning organization to 100+ Women Strong Inland Mendo at P.O. Box 1349, Ukiah, CA 95482.
Required
Image Use *
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 Strong Inland Mendo. I understand that my name and images of myself may be posted to the 100+ Women Strong Inland Mendo website, Facebook page and other media outlets.
Required
Membership Directory *
If 100+ Women Strong Inland Mendo chooses to publish a Membership Directory, I agree that my contact information be included in that directory.
Required
Commitment / Signature *
Type your name and check below to indicate that you are committing to join 100+ Women Strong Inland Mendo.
Your answer
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.
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