Membership Registration – Individual & Team - Live - v20260121

Membership Registration – Individual & Team

ver.20260121

Participation Type

Please let us know how you are participating in 100 Women Who Care Timmins & Area.

How are you participating?

Individual

Team (two people sharing one membership)

Primary Member Information

This person will be the primary contact for the membership, including payment confirmations and communications.

First Name

Last Name

Confirm Email

Phone/Mobile

Mailing Address:

Address Line 1

Address Line 2

City

Province

Postal Code

Second Member Information

This person is included as part of the shared membership but is not the primary contact for payment or official communications.

These details are required when registering as a Team. This person shares the membership and vote but is not the primary contact for payments or official communications.

I am completing this Commitment Form on behalf of myself and my Team Member with their consent

Yes

Second Member First Name

Second Member Last Name

Second Member Email

Confirm Second Member Email

Second Member Phone/Mobile

Second Member Mailing Address

Address Line 1

Address Line 2

City

Prov

Postal Code

Commitment

With my / our virtual signature below:

> I / We agree that the information provided is accurate and true

> I / We am pledging to participate in 100 Women Who Care - Timmins & Area, and I am making a personal commitment to contribute $400 each calendar year ($100 quarterly) to local beneficiaries serving Timmins and Area region

> I / We agree to donate each quarter to the beneficiary selected by the group's majority vote. If I am unable to attend a quarterly meeting, I will arrange payment in advance or send my donation to another member to deliver on my behalf

> I / We acknowledge that photographs and videos taken at events and meetings may include my image and may be used in promotional materials for 100 Women Who Care - Timmins & Area

> I / We understand that my personal contact information is kept confidential and will not be shared with third parties without my consent except for the purpose of the beneficiary issuing income tax receipts

Commitment Acceptance

I / We Accept The Commitment As Outlined Above

How did you hear about 100 Women Who Care - Timmins & Area?

Membership Commitment Submission And Withdrawal Process

Completed Commitment Forms will be submitted to the Steering Committee and a copy will be sent to you via email.

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

Signature - Primary Member (My name as entered below acts as my signature):

Date (DD/MM/YYYY):

Signature - Second Member (My name as entered below acts as my signature):

Date (DD/MM/YYYY):

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