* Please provide at least one of the following:
* Membership: A $1,000 membership provides voting rights for one person. 2017 membership contributions are due no later than March 31, 2017.
Confidentiality and Conflicts of Interest: I understand that confidential information may be acquired as a result of my association with Impact 100 Garden State, and that this information should not be disclosed. To insure a fully transparent grant selection process, I will disclose to the leadership of Impact 100 Garden State any potential conflicts of interest I may have with grant applicants.
Please send check by 3/31/2017 to:
Impact 100 Garden State
PO Box 488
Mendham, NJ 07945