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Donation

* Mandatory fields
*First name
*Last name
*Email
Cell Phone
*Options ($USD)
*Cardholder
Name on credit card
 Payment Frequency
Annual Payment Agreement
Type your initials to accept Annual Payment Agreement.

Note: may be cancelled at any time before next payment date by email to treasurer@impact100westchester.org
*Membership Type
If Gift Membership:
Name, email and cell for each recipient of Gift Membership
If Honor/Memory of Donation:
Name and email for Honoree acknowledgement
If Corporate Matching Gift:
Name of Company and name of Employee if different than name of Member
 


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Copyright 2023.  Impact100 Westchester, Inc. is a 501(c)(3) nonprofit organization.  EIN 46-1103703.  PO Box 634, Hartsdale, NY 10530-0634

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