Renew your Impact100 Essex membership today

Thank you for recommitting to our organization, and to the many nonprofits we support through our Impact and Equity Grants. Membership is an annual $1,100 tax deductible donation, with $1000 designated directly to our grantees and $100 to support our chapter's operating expenses.

Renewing is simple and takes two steps:

Step 1. Share your most up-to-date contact details below. Please note fields marked * are required, INCLUDING THE FIRST FIELD "MEMBERSHIP LEVEL" THERE IS ONLY ONE CHOICE, BUT PLEASE CHECK IT.

Step 2. After you fill out this form and press "Submit", please follow the instructions on the next page and pay your membership dues by May 31. Please hit submit on the second page as well. You will receive a welcome email indicating your renewal form was received.

Membership Level (REQUIRED. PLEASE CHECK THE CIRCLE DIRECTLY BELOW NEXT TO MEMBERSHIP):

Impact100 Membership $1,100 (Renew)

First Name: Last Name: Company: Preferred Email: Preferred Phone: Home Address: City: State: Zip: -

Payment Options

All payments are made to, and through the Community Foundation of New Jersey (CFNJ), Impact100 Essex's fiscal sponsor. CFNJ Tax ID/EIN is 22-2282783.

Please select from the following options:

I will mail a $1,100 check made payable to the Community Foundation of NJ and note "Impact100 Essex/IMPESX" on the memo line. Mail to CFNJ, Attn: Impact100 Essex/Alicia Nager, P.O. Box 338, Morristown NJ, 07963.

I will pay by stock transfer.

I will make a grant through a Donor Advised Fund (DAF).

I will pay online by credit card.

I will pay online, in installment payments by credit card.

WOULD YOU LIKE TO MAKE AN ADDITIONAL DONATION? Support member fellowship and scholarships to increase our granting ability. Help underwrite some of the administrative expenses related to running our chapter which includes website hosting, grant management software and training events.

$250

$500

$1100

Other amount

GIFT MATCHING:

Yes, through my employer.

Yes, through my partner's employer.

No.

I'm not sure.

If yes, please tell us the Name of your or your partner's Employer.

Optional:

Do you identify as Black, Indigenous and other People of Color (BIPOC).

Yes

Prefer not to answer

Confidentiality and Conflicts of Interest Statement

Confidential information regarding members and nonprofits may be acquired as a result of membership with Impact100 Essex. This information may not be disclosed.
Members electing to participate in grant review will disclose any potential conflicts of interest to ensure a fully transparent and fair process.

Terms of Agreement - Confidentiality and Conflicts of Interest

I have read and agree to all terms outlined in the Impact100 Essex Confidentiality and Conflicts of Interest Statement.

Photo Release Statement

Photographs taken at Impact100 Essex events containing member images may be published electronically or in printed material for the purpose of promoting Impact100 Essex.

Terms of Agreement - Photo Release

I agree to allow Impact100 Essex to use photos as described.

I do not agree to allow Impact100 Essex to use photos as described.

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