Member 1 Name *

First Name

Last Name

Member 1 Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Member 1 Cell Phone *

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Member 1 - If you would like to share, please provide the month and day of your birthday. Please note, the year is not necessary but the form requires a year so please enter 1900.

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Member 2 Name *

First Name

Last Name

Member 2 Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Member 2 Cell Phone *

(###)

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Member 2 - If you would like to share, please provide the month and day of your birthday. Please note, the year is not necessary but the form requires a year so please enter 1900.

MM

DD

YYYY

How did you hear about 100 Women Who Care Door County? Please check all that apply. *

Advocate

Facebook

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Poster

Pulse

Pulse Podcast

Radio

Word of mouth

Commitment to Nonprofits *

We understand that we are making a commitment to 100+ Women Who Care Door County to each make an annual donation of $200 ($50 per quarter) for a total team commitment of $400 ($100 per quarter) to local 501(c)(3) nonprofits serving the Northern Door, Washington Island and Sturgeon Bay Communities.

Yes

We understand that: *

- This is an HONOR agreement, not a legal agreement. - Even if we do not vote for the Main Award recipient, we are committing to fulfill our donation commitment. - Our membership will automatically renew for successive one (1) year periods. - We may withdraw at any time by contacting 100+ WWC Door County. - Photographs and videos taken at events and meetings may include our images and may be used in promotional materials for 100+ Women Who Care Door County.

Yes