Commitment Form - 100womentricitiesbc

100 Women Tri-Cities BC Registration and Commitment Form

First Name

Last Name

Address

City

PROVINCE

POSTAL CODE

Phone

Date

I understand my personal contact information is strictly confidential and will not be shared or distributed to an outside third party without my expressed consent. If 100 Women Tri-Cities BC chooses to publish a membership directly, I agree that my contact information can be included in that directly.

Yes No

I agree that the information I have provided is accurate and true. I am pledging to participate in 100 Women Tri-Cities BC, and I am making a personal commitment to contribute $400 each calendar year ($100 quarterly) to local non-profit organizations serving the Port Moody/Coquitlam/Port Coquitlam region. I agree to donate each quarter to the non-profit organization selected by the group’s majority vote. If I am unable to attend a quarterly meeting, I will either send my cheque with another attending member to deliver on my behalf, mail it as requested after the meeting, or pay online, if that option is presented. 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 Tri-Cities BC.

I agree

Yes, I would like to sign up to receive updates and special event news via email.

Yes