Registration and Commitment Form 100 Women Who Care Michiana

Commitment:  With my signature below, I am agreeing that the information I provide below is accurate and true.  I am pledging to participate in 100 Women Who Care Michiana and I am making a personal commitment to contribute $400 each calendar year ($100 Quarterly) to local nonprofit organizations serving the 100 Women Who Care Michiana region.  I agree to designate my $100 quarterly donation to the nonprofit organization selected by the group’s majority vote conducted at each quarterly meeting.  If I am unable to attend a quarterly meeting, I will either:

  • Send my donation check with another member attending the meeting to contribute on my behalf;
  • Make my contribution online

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 Who Care Michiana. I understand that my personal contact information is strictly confidential.  Representatives of 100 Women Who Care Michiana may contact me regarding meetings and quarterly contributions. I also understand my contact information will not be shared or distributed to an outside third party without my expressed consent.

If 100 Women Who Care Michiana chooses to publish a membership directory, my contact information may be included in that directory.

    1 – Select Single Donation

    2 – Select “Individual” (unless it’s from your company)

    3 –  Your information

    4 – Your amount and SELECT “100 WOMEN WHO CARE MICHIANA”

    5 – Optional information

    6 – Your payment details