Join Us

Register Online

Simply select the form from the list below.

Membership Form

If you would like to become a member, please fill out and submit the Membership Form below. You may also print, scan and email this Membership Form to info@powerof100southwest.com or you can bring it to the next meeting.

* Name

First

Last

* Address

Street Address

Address Line 2

City

State

ZIP Code

* Phone

* Email

Email

Confirm Email

How did you learn about Power of 100 Southwest?

Agreement

I understand that I am making a commitment to Power of 100 – Southwest - Women Who Care to make an annual donation of $400 ($100 at each meeting) given directly to local non-profit charities serving Minnesota. I understand that even if I did not vote for the charity selected by majority vote, I will fulfill my donation commitment. I also understand that if I am not able to attend a meeting, I can provide my check to another member to deliver on my behalf. Members not in attendance will be notified via email and can also mail a check within three days to an address provided.

By submitting this form, I grant my permission for Power of 100 to email me and use photographs or videos of me taken at Power of 100 events. Should you wish to discontinue membership at any time, please send us an email indicating your withdrawal. Power of 100 Southwest - Women Who Care thanks you for your support!

*

Team Membership

Team Membership Form (2 to 4 person teams)

If you would like to become a member along with your team of up to four people, please fill out and submit the Team Membership Form below. You may also print, scan, and email this Team Membership Form to info@powerof100southwest.com or you can bring it to the next meeting.

* Team Name

* Responsible Party Name

* Email

Email

Confirm Email

Team Member #1

* Team Member 1 - Name

First

Last

Team Member 1 - Address

Street Address

Address Line 2

City

State

ZIP Code

* Team Member 1 - Phone

* Team Member 1 - Email

Email

Confirm Email

Team Member #2

* Team Member 2 - Name

First

Last

Team Member 2 - Address

Street Address

Address Line 2

City

State

ZIP Code

* Team Member 2 - Phone

* Team Member 2 - Email

Email

Confirm Email

Team Member 3

* Team Member 3 - Name

First

Last

* Team Member 3 - Address

Street Address

Address Line 2

City

State

ZIP Code

* Team Member 3 - Phone

* Team Member 3 - Email

Email

Confirm Email

Team Member 4

* Team Member 4 - Name

First

Last

* Team Member 4 - Address

Street Address

Address Line 2

City

State

ZIP Code

* Team Member 4 - Phone

* Team Member 4 - Email

Email

Confirm Email

*

Charity Nomination Form

Fill out our electronic nomination form below or download our Charity Nomination Form to scan and fax or email back to us. Requirements of submission: – Must be a 501(c)(3) [IRS Certified Tax Free Status] – Organization must have been in existence for a minimum of 2 years. – Charity must benefit Minnesota. – National charities will be considered if 100% of the donation will benefit Minnesota.

* Member Name

First

Last

* Member Email

Email

Confirm Email

* Member Phone

* Name of Charitable Organization

Name of organization contact and/or executive director.

* Address: (Headquarters and where services are provided, if different)

How long has the organization been in existence (required minimum of 2 years)?

Mission Statement and/or purpose of the organization:

How would the donated funds be used?

What population does the Organization serve? (children, elderly, mentally ill, etc.)

Approximately how many people receive services annually from this Organization?

Is the organization a registered 501(c)(3) (IRS Certified Tax Free Status) charitable organization? If possible, provide the organization’s EIN#.

If selected, would someone from the organization be available to speak at our next meeting to describe the impact of the donated funds?

If this charity is selected by the group, to whom would the check be payable?

If known, what percent of the charity’s annual budget is spent on administrative fees?

Are you a board member or employee of this organization?

No

Yes

*

Thank you so much for your interest in joining Power of 100 Southwest – Women Who Care

Register Online

Membership Form

Team Membership

Charity Nomination Form

Contact Us!

Upcoming Events