Membership Form

Join Impact 100 / 2021-2022

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.

Thank you! Your information has been sent successfully!

Please make sure all contact information is filled in above.

If you are still experiencing problems, please contact us
or try again later.

For questions, concerns, or issues with this form,

please call our office at  (561) 336 - 4623