Membership/Commitment Form


Commitment: By filling out the form below, I am agreeing that the information I provide below is accurate and true. I am pledging to participate in 100 Men Who Give A Damn – Central Ohio, and I am making a personal commitment to contribute $300 each calendar year ($100 at each of the three meetings) to local deserving organizations in the greater Columbus 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 meeting, I will either send my check 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 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.

PLEASE NOTE: If the membership is full, you will automatically be placed on a wait list.

Member Info
First Name:	Last Name:
Nickname:	(will show up larger on your name badge)
Address:
City:		State:	Zip:
Best Phone Number:
Email:

Company(Optional):

Do you have a sponsor or friend within the current 100 Men group?

Name of sponsor or friend:


Enter your Initials here:	(by Initialing here you agree to all the terms above)

Should you wish to discontinue membership at any time after your four-time commitment, please send an e-mail to 100Mencmh@gmail.com indicating your withdrawal.

- denotes required fields

Over $300,000