2027 MEMBERSHIP DONATION FORM

upLoading...

Redirecting you to a secure payment page…

HOME
{{profilePhoto.url?'':accountBasicInfo}}
- MY PROFILE
- Dashboard
- Log out

Membership 2027

$1,100 Membership for 2027

Other Amount (TOTAL)

{{donationOtherAmountLabel}} *

USD

Donor Note

Please note any specific considerations regarding any contribution above $1,100 such as allocations to "Scholarship" or "Above and Beyond" fund. Donations above $1,100 without a note will be allocated to the "Above and Beyond" fund.

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

First Name *

Last Name *

Email *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

Phone 1

Data Privacy & Consent

Do you consent to Text Messaging?

Please create an account to save your information and access our online portal!

Password

Retype Password

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Are you a New or Renewing Member? *

How did you hear about Impact?

Please include names of anyone who referred you so we can thank them.

Demographics: Race/Ethnicity

Demographics: Age Category

Employee/Profession:

Does your employer offer Matching Donations?

Name of Employer for Matching Donation:

Would you like to join a Grant Review Committee? *

Grant Review Committees will meet on Feb 24 and April 7 with site visits scheduled in between those dates.

Would you like to join the Financial Review Committee?

The Financial Review Committee Final meeting will be on Feb 23. Prior to that date training and group meetings will be scheduled.

Would you like to join an LOI Committee? At least one year of Review Committee participation is required.

The LOI Committee will meet on Jan 12. Training will be required for new LOI participants.

Please note your preference(s) for your Grant/Financial Review Committee Meeting times. Select all that apply.

Daytime Meetings

Evening Meetings

Virtual Meetings

Review Committee Friend Request (Name of Friend):

What Conflicts of Interest should we consider? (A potential conflict of interest can arise in situations when a member, or someone in a member’s immediate family, would personally gain, either financially or professionally, from an action taken by Impact Fairfield County. Serving on the Board of Directors of an Exempt Organization that has applied for an Impact Fairfield County Grant does create a conflict of interest.) Please list all applicable organizations. *

Please note "NA" if you do not have any Conflicts of Interest or if you do not plan to participate in the grant review process.

Will you submit payment using a DAF (Donor Advised Fund)?

If payment will be via DAF or Check, please note your administrator/bank name.

If you are submitting via a DAF, please provide the name of your DAF if different from your name.

Are you willing to include your Email/Phone in a Member Directory?

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Card

Pay Later

or enter your card details below

Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card *

Payment Form Unable to Load: Your payment form is blocked by a firewall. This is most commonly due to use of an anonymous, untrusted IP address. If you are using a VPN to anonymize your IP, we recommend connecting through your local IP to complete your payment.

Billing address is the same as mailing address

Address Line 1

Address Line 2

City

State/Province

Zip *

Country

I will mail in a check or money order

Please mail your payment to:
Impact FFC
PO Box 7666
Greenwich, CT 06836

Amount:

{{donationAmountStr}}/{{recurringUnitText}} USD

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Impact Fairfield County 2027 Membership