100 Women Who Care: Registration and Commitment Form

100+ Women Who Care: Powell River Chapter

Registration & Commitment Form
Welcome! We are thrilled that you would like to join 100+ Women Who Care: Powell River Chapter. Let's get started ...
Please indicate your membership type: *

Adult Membership (19 + years of age) Junior Membership (18 years old or younger)

Click here to proceed with your registration!
Commitment: With my initials below, I am agreeing that the information I provide is accurate and true. I am pledging to participate in 100+ Women Who Care – Powell River Chapter, and I am making a personal commitment to contribute the following to local registered non-profits/charities serving the Powell River region:
- Adult Members: $200 each calendar year ($50 quarterly)
- Junior Members: $80 each calendar year ($20 quarterly)
I agree to donate each quarter to the registered non-profit/charity organization selected by the group’s majority vote. If I am unable to attend a quarterly meeting, I will send my cash or cheque with another attending member to deliver on my behalf. 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 – Powell River Chapter.

I understand that my personal contact information is strictly confidential and will not be shared or distributed to an outside third party without my expressed consent.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail *
We will add you to our electronic mailing list so that you can receive meeting reminders and updates. We will never share your email address with a 3rd party.
Phone Number *

Area Code Phone Number
Name of Nominated Charity or Non-Profit** *
**Your charity or non-profit does not have to be registered to be nominated. However, before voting takes place, all selected nominees will need to present to the members on what they do for our community, how long they have been in existence, and what they plan to do with the funds if they are the recipient organization.
Please note: If the recipient organization is a registered charity, you can request a tax receipt that can be used to claim charitable tax credit. However, many of the nominated organizations have non-profit status which means that although they can issue you a receipt for your donation, you will not be able to use it to claim charitable tax credit.
Date *

Month Day Year
Please Initial Here *
Should you wish to discontinue membership at any time after your four-meeting commitment, please send an e-mail to 100womenpr@gmail.com indicating your withdrawal.
Should be Empty:

100+ Women Who Care: Powell River Chapter