Membership application

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* 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

Impact 100 Garden State is a Special Project Fund of the Community Foundation of New Jersey, which is a nonprofit organization with 501c(3) status. As such, all contributions to Impact 100 Garden State are tax-deductible to the fullest extent of the law.