NextGen Membership Form Join IMPACT 100 Owensboro Next Generation The join form is used to create user accounts and register new members. Step 1 of 2 - Member Information 50% Name(Required) First Last Current School Grade of Current School Year Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Member Email(Required) Enter Email Confirm Email Member PhoneThe primary phone number where you can be reached.Parent/Guardian Name(Required) First Last Parent/Guardian Email(Required) Enter Email Confirm Email Parent/Guardian Phone(Required) NextGen Membership(Required) Full Membership ($100) By submitting your membership, you are obligated to pay the $100 donation regardless of your involvement due to your membership being included in the grant total.Choose your preferred payment option for Amount Due:(Required) Will Mail Check Will Pay Now by Credit Card Amount Due by CheckPlease make your check payable to Impact100 Owensboro and send to: Impact100 Owensboro Next Generation 117 E. 18th Street, #2290 Owensboro, KY 42302 Full payment must be made by August 31.Amount Due by Credit Card Price: Total Credit CardCard Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.
