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Membership Form

Join Impact 100 / 2023-2024

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


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 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

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