Membership Application

Thank you for joining Impact100 Metro Detroit. We are Fueling Transformation Together.

Please choose one (1) membership level below.

Individual - you are paying for your membership (either on line or via check/PayPal).
Individual w/ Corporate Match - your company will pay a portion of your membership (click "PAY LATER" on the following page).
I Am Sponsored - your membership will be paid in full by your employer or another indivudual (click "PAY LATER" on the following page).
Apply for Support - you will fill out an application (on the next page) for full or partial support from Impact100 Metro Detroit (click "PAY LATER" on the following page).
Pay via Charitable Trust - you will fill out a form on (on the next page) with the name of the trust (click "PAY LATER" on the following page).

Membership Level:

Individual Join - $1,100

Individual w/ Corporate Match

I Am Sponsored

Apply for Support

Pay Via Charitable Trust

Pay In Monthly Installments

First Name: Last Name: Company: Email: Phone: Address: City: State: Zip: - How Did You Hear About Us? If you heard about us from a person, company, or nonprofit, please enter name: As a member, I would like to be involved in the following ways (check all that apply).

Meet others via social events

Network with other business people

Participate in the Grant Review process

Volunteer or help lead other volunteers

Vote on which nonprofits will be awarded grants

* I would like to help make Impact100 Metro Detroit memberships accessible to women needing financial support. (Please click HERE to make a donation.)

By submitting my membership, I agree:

That photographs with my image taken at Impact 100 Metro Detroit events may be published electronically or in printed materials.
To proactively disclose to the President any actual, potential or perceived conflicts of interests that may exist during the grant review process.
To keep confidential ALL information acquired in connection with the work I do on behalf of Impact100 Metro Detroit. This could include, but is not limited to, member contact information and non-profit grant information.

If you would like to manage your Neon CRM account (i.e., view donation history, renew membership, etc.), please create a login name and password below. Your password must be at least eight characters long, and contain at least one number.