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Club 100 Membership Application

Want to become a member of Club 100? Please complete the form below...

Name *

Address

City, State, Zip

Email *

Phone

Preferred method of contact

Why do you want to be part of Club 100?

Personal brief history

What Club 100 areas are you interested in?

Public Relations
Board Development
Fundraising
Social Media planning
Program planning and evaluation
Investing & Financial planning
Other (please specify)

Other area of interest

Comments or Questions:

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Club 100 Charities, Inc is a 501(c)3 nonprofit organization. Federal Tax ID# 20-3929694. Florida Registration #CH41548.
A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED
FROM THE DIVISION OF CONSUMER SERVICES BY CALLING 800-435-7352 WITHIN THE STATE.