Registration & Commitment Form

Commitment: By completing the form below, I am agreeing that the information I provide below is accurate and true. I am pledging to participate in 100 WWC ROC, NY and I am making a personal commitment to contribute $400 each calendar year ($100 quarterly) to local nonprofit organizations serving the greater Rochester, NY region. I agree to donate each quarter to the nonprofit organization selected by the group’s majority vote whether I am able to attend the meeting or not. 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 WWC ROC, NY.

We are excited to have you join our Giving Circle. All our communications and transactions are through the Grapevine Portal. As soon as you submit the form below you will be redirected to register and join our giving circle. Once established you are ready to go! THANK YOU for joining us on our journey to collectively make an impact in our community. We look forward to seeing you via ZOOM at our next quarterly meeting. If you have questions, contact us at 100wwcrocny@gmail.com.

COMMITMENT FORMS MUST BE submitted no later than 1 Week prior to the quarterly meeting. (meeting schedule)

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Referred by

Confidentiality Agreement

My personal contact information is strictly confidential and I understand it will not be shared or distributed to an outside third party without my expressed consent. If 100 WWC ROC, NY chooses to publish a Membership Directory, I agree that my contact information be included in that directory.

Agree