100+ Women Who Care Victoria

Thank you for your interest in becoming a 100+ Women Who Care Victoria member. Please fill out the form and submit. By hitting submit, you understand that you are committed to fulfilling your membership obligations.

A member of our organizing committee will be in touch with you shortly to welcome you and give you more information. But please read through our website for lots of great information. Thank you and welcome!

* indicates required

Email Address *

First Name

Last Name

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Phone Number *

( ) -

Alt Phone Number

( ) -

Date Submitted

Type Name Here as Signature

FIRST LAST NAME

Name of Nominated Charity

Charity Contact Phone Number

Charity Contact Email

Member Email Address

Member Phone Number

Member First Name

Member Last Name

Contact Name at Charity

Charity Website

What is the Charity's Mission Statement?

Who does the Charity Serve?

What would the donated funds be used for?

Charity Registration Number

Does the Charity know we will be contacting them?

Is the Charity a registered not-for-profit?

Expectations of winning Charity include:

Ability to speak at our next meeting
Will not use 100+ Member List for any purpose other than tax receipting
Will not solicit our members in the future for any reason