Membership Application

Contact Information

- Preferred phone type Alternate phone type

 

Membership Contributions

 
Impact100 Greater Milwaukee is a non-profit organization exempt from federal taxes under IRS Code 501(c)(3)
All contributions are tax-deductible to the extent allowable by law.

FOR MATCHING FUNDS:  My company will not receive voting or other membership rights.  Matching funds must be received by December 31.

PUBLICITY   I grant Impact100 Greater Milwaukee permission to publish my name and/or photograph in its promotional materials and any other internal documents or communications.

CONFIDENTIALITY  I will not discuss confidential information acquired in connection with the work I do on behalf of Impact100 Greater Milwaukee.

CONFLICT OF INTEREST  To insure a fully transparent grant selection process, I will disclose to the Impact100 Greater Milwaukee Board of Directors, each year I am a member, affliations I may have with any Impact100 Greater Milwaukee grant applicants prior to participating in a grant or financial review committee.  I understand that I may be asked to refrain from discussion on any topic where a potential conflict of interest arises.  In addition, I will not attempt to gain an advantage for, or to persuade other members to vote for, any particular applicant. 

 

Create an Account

Prior to final submission of this form, you are asked to indicate preferred method of payment for your membership and other (optional) contributions.  Credit Card payments will incur a $25 processing fee.  Payments by check are welcome and should be mailed to Impact100 Greater Milwaukee, P.O. Box 1061, Brookfield, WI 53008.  Regardless of payment method, please create a login now, which will be utilized to access your account. 

 

 

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