Become a Member

A two-step process:
1. Fill out a form
2. Submit payment

Membership in Impact Fairfield County is conditioned upon receipt of a $1,000 non-refundable donation and this signed form. Contributions are due by December 31st.

WAYS TO JOIN:

Join Online: Fill out the form here and click link to pay online

Join by Check, Donor Advised Fund or Foundation: Fill out the form here and mail a check to: Impact Fairfield County, PO Box 7666, Greenwich, CT 06836

To Sponsor a Member: Fill out a Donation Form

 

Step 1

Name *
Name
Address *
Address
Phone *
Phone
Type of Membership *
Contribution *
I would like to serve on a Review Committee
I require evening Review Committee Meetings
I would like to share my expertise or volunteer with:
Confidentiality *
I will not disclose confidential information acquired in connection with the work I do on behalf of Impact FFC. I agree not to share members’ contact information outside the membership. I understand that the membership list will be distributed to other Impact FFC members, and made available on our website and printed materials. I agree that my image may be used in photographs to promote Impact FFC via the website or other materials.
Conflict of Interest *
To ensure a fully transparent grant selection process, I will disclose to the Impact FFC board of directors any potential conflict of interest that I may have with Impact FFC applicants. I understand that I may be asked to refrain from discussion on any topic where a potential conflict of interest arises. Also, I will not attempt to gain an advantage for or to persuade members to vote for a particular application.
Date
Date

Step 2

Membership is not completed until finishing next step:

*I will donate via check, donor advised fund or foundation and a check will arrive separately.

NOTE: If you select Pay By Check, we will automatically receive your completed membership form and await your check by mail.