Membership Form
Join Impact 100 / 2022-2023
Please use the below form to request information, about our membership. Note if you plan to pay for your dues from a donor advised fund please contact our organization to confirm our correct address (261 NW 13th Street Boca Raton, FL 33432) and tax ID number (82-4558049).
Basic Information
Participation
As a voting member, I am interested in actively participating as a volunteer on the following committee(s):
* Volunteer may be asked to submit a curriculum vitae and/or history of volunteerism specific to these committees
A copy of the official registration and financial information for Impact 100 Palm Beach County Inc., a Florida-based nonprofit corporation (Registration No. CH60185), may be obtained from the Division of Consumer Services by calling toll free 1-800-HELP-FLA (435-7352) within the state or visiting their website at www.freshfromflorida.com. Registration does not imply endorsement, approval, or recommendation by the state. Federal Tax ID Number: 82-4558049.
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For questions, concerns, or issues with this form,
please call our office at (561) 336 - 4623