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100 Women Who  Care Brantford

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Commitment Form to Join 100 Women Who Care Brantford

I understand that I am making a commitment to 100 Women Who Care Brantford to make an annual donation of $400 ($100 at each of four meetings) given directly to local charities, non-profits and other worthy causes serving Brantford & Brant County.  I agree to fulfill my donation commitment even if I did not vote for the charity selected by majority vote.  I also agree that I will provide my cheque to another member to deliver in my place if I am not able to attend a quarterly meeting.

Should I wish to discontinue my membership at any time, I will send an email to info@100womenbrantford.com indicating my withdrawal.


100 Women Who Care Brantford thanks you for your support!
First Name:
Last Name:
Address:
City:
Postal Code:
Phone:
Email:

How did you hear about 100 Women Who Care Brantford?:

Charity Nomination Form

Please fill out the information below about the charity you would like to nominate.
(Please note you must be a member of 100 Women Who Care Brantford to nominate a charity).

Your Name:

Your Email:

Are you currently a member of 100 Women Who Care Brantford?

Name of Organization/Charity you would like to nominate:

Organization/Charity's Website:

Mission Statement:

The Organization/Charity is a registered not-for-profit/charity able to provide tax receipts:

How long has the charity been in existence:

Charity Registration # :

The Organization/Charity serves the following population:

The donated funds would be used for:

The Organization/Charity's current sources of funding are:

If selected, someone from the Organization/Charity would be able to speak to our group at a future meeting to describe the impact of the donated funds:

The Organization/Charity agrees not to sell, give, or use the 100 Women Who Care Brantford contact information for solicitations:

The Organization/Charity agrees that none of our donation money will be used for administration costs:

If selected, cheques should be made payable to:

If selected, e-transfers should be forwarded to:

Comments:

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