Membership FormMembers Member DataSubmitting this form is making a commitment to 100+ Women Who Care – Southern Maine to make an annual donation of $200 ($50 for every quarterly meeting), even if you cannot attend a meeting. First Name * Last Name * Email Address * Fill in at least one of the phone numbers. 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/Postal I agree to have my contact information included in the 100+ WWC Membership Directory * Yes No I understand that * I am making a commitment to 100+ Women Who Care – Southern Maine to make an annual donation of $200 – ($50 for every quarterly meeting) – given directly to local charities/non-profits serving the Southern Maine area. I understand that * Even if I did not vote for the charity chosen by majority vote, I will fulfill my donation commitment. I understand that * Even if I am not able to attend a quarterly meeting, I will mail in a check or provide my check to another member to deliver. Terms and Conditions * I agree to the above Terms and Conditions reCAPTCHA Submit If you are human, leave this field blank.
