100 Women Who Care-Michiana Registration & Commitment Form

Commitment:  With my [digital] signature below, I am agreeing that the information I provide below is accurate and true.  I am pledging to participate in 100 Women Who Care- Michiana, and I am making a personal commitment to contribute $400 each calendar year ($100 Quarterly) to local nonprofit organizations serving the 100 Women Who Care- Michiana region.  I agree to designate my $100 quarterly donation for the nonprofit organization selected by the group’s majority vote conducted at each quarterly meeting.  If I am unable to attend a quarterly meeting, I will either:

  • Send my donation check with another member attending the meeting to contribute on my behalf;
  • Mail my check to one of the meeting organizers; or
  • Make my contribution online

I also acknowledge that photographs and videos taken at events and meetings may include my image and may be used in promotional materials for 100 Women Who Care- Michiana.

I understand that my personal contact information is strictly confidential.  Representatives of 100 Women Who Care-Michiana may contact me regarding meetings and quarterly contributions. I also understand my contact information will not be shared or distributed to an outside third party without my expressed consent. 

If 100 Women Who Care – Michiana chooses to publish a membership directory, my contact information may be included in that directory.

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