Membership Form Members Member Data Submitting 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 Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 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.