Commitment Form | 100 Women Who Care

Please use the form below to indicate your Commitment to 100 Women Who Care Burlington. If you are making a Commitment as part of a team, each person should provide their information by filling out the form below and use the Additional Notes section to communicate how the $100/$50 donations will be split between team members.

Name - Please also Include Team Name if signing up as a Team *

Email *

Address *

City *

Postal Code *

Phone Number *

How did you hear about 100 Women Who Care Burlington?

Additional Notes

I understand and agree with the below statement *

Agree

I understand that I am making a commitment to 100 Women Who Care Burlington to make an annual donation of $400 ($100 at each of four meetings) or $200 for those under 30 years old ($50 at each of four meetings) – given directly to a local charity or one of its valuable programs that serves the Burlington community. I agree to fulfill my donation commitment even if I did not vote for the charity selected by majority vote. I also agree that I will donate online or send my cheque to the charity if I am not able to attend a quarterly meeting.

I agree to have my contact information included in the 100 Women Who Care Burlington Membership Directory. 100 Women Who Care Burlington collects your personal information (including name, address, email address, phone number) strictly for the purpose of maintaining our membership list. 100 Women Who Care Burlington will not sell, give or otherwise share your personal information without your express consent, unless required by law.

Agree

Should you wish to discontinue membership at any time, please send an e-mail to info@100womenwhocareburlington.com indicating your withdrawal.