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 $400 each calendar year ($100/ quarterly) 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 quarterly 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):
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

Money Given To Date

$65,000