Join Impact100 Owensboro Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Mobile PhoneSecondary PhoneA fallback phone number we may use to get in touch with you.Impact 100 Owensboro is a non-profit organization exempt from federal taxes under IRS Code 501(c)(3). All contributions are tax-deductible.Membership Options* 110% Membership* ($1,100) Full Membership ($1,000) Half Membership ($500) *I understand that 100% of my $1,000 membership will be used exclusively to fund the grants awarded by Impact 100, and the extra $100 will be used to offset operating expenses.Additional Gift You may make a donation in addition to your membership fee (or 110%). The Additional Gift will not be included in the grant, but rather will be used to offset operating costs. Additional Notes My company makes matching contributions** Please contact me regarding a gift of stock ** Only at the discretion of the Board of Directors will this money be included in a grant.Volunteer Opportunities Focus Groups (May through August) Grants Committee Events Membership/Recruitment Communications New Member Mentorship Welcome Committee – Help with events Food – Bring food for events Accounting & Finance Expertise Legal Expertise Technology – website design and hosting, content updates Technology – software systems and data integration Graphic Design Photography Public Relations, Writing, Publicity/Communications Social Media Select all that apply.Permission to publish name* I grant IMPACT 100 Owensboro permission to publish my name in donor appreciation listings I DO NOT want IMPACT 100 Owensboro to publish my name in any donor appreciation listings Subscribe I want to stay informed! Please send me news and updates about IMPACT 100 Owensboro Payment Method* Credit Card Will Mail Check Invoice Me Member pledges are counted toward our total giving and are due regardless of the member's participation level throughout the year. By clicking the button below you acknowledge that your membership may be paid in installments with your pledge being paid IN FULL by August 31. Yes, I understand that my pledge will be paid in full by August 31. Monthly invoices will be emailed to the address you have provided. You can make installment payments or send in one payment, whichever you prefer.Please make your check payable to Impact100 Owensboro and send to: Impact100 Owensboro 117 East 18th Street, #2290 Owensboro, KY 42302Total $0.00 Credit CardCard Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.