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I want to become a 110% Member of Impact100 Essex by making a tax-deductible donation of $1,100 (I understand $100 will cover operational expenses).

Payment Options *
I will mail my membership check for $ 1,100 made payable to the Community Foundation of NJ. Please note Impact100 Essex on the memo line. I prefer to pay by credit card (Visa/Mastercard) and I will donate online at this Community Foundation website (link below). Please note, the Community Foundation assesses a 3% fee for making a contribution by credit card. I will pay by stock transfer through the Community Foundation I plan to submit my gift to Impact100 Essex to my employer for a matching gift donation.

I understand that confidential information may be acquired as a result of my association with Impact100 Essex, and that this information should not be disclosed. To insure a fully transparent grant selection process, I will disclose to the leadership of Impact100 Essex any potential conflicts of interest *

I Agree with the Confidentiality and Conflict of Interest Terms *