Membership FormMembers Commitment form100+ Women Who Care Southern Maine thanks you for your support!I understand that * I am committing to donate $50 for each quarterly meeting ($200 annually) directly to the selected charities for 1 year. I understand that even if I did not vote for the charity chosen by majority vote, I will fulfill my donation commitment. If I am unable to attend a quarterly meeting, I will provide my check to another member to deliver at the meeting, mail a blank check to 100+WWCSM in advance of the meeting, mail a check to 100+WWCSM made out to the selected charity immediately upon receiving word of the meeting selection, or donate by credit card through Grapevine. My 12-month membership will automatically renew unless I notify 100 Women otherwise. I will inform 100+WWCSM if at any time I no longer wish to be a member. I may choose to nominate a local charitable organization after I have attended and donated for 2 meetings. First Name * Preferred Name Last Name * Email * At least one phone number required Phone Home Phone Work Phone Cell Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/PostalI agree to have my contact information included in the 100+ WWCSM Membership directory. * Yes No Captcha Submit If you are human, leave this field blank.
