Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date *

MM

DD

YYYY

I understand 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 Women Sea to Sky chooses to publish a Membership Directory, I agree that my contact information be included in that directory. *

Yes

No

I agree that the information I provide below is accurate and true. I am pledging to participate in 100 Women Sea to Sky, and I am making a personal commitment to contribute $400 each calendar year ($100 quarterly) to local nonprofit organizations serving the Squamish/Whistler/Pemberton region. I agree to donate each quarter to the nonprofit 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 Sea to Sky. *

I agree

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