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Fill out this online Membership Commitment Form and pay online (please include 3% additional for transaction fee costs so that 100% of your membership donation will be part of the grant award).

OR download the form, fill it out and mail it with your Membership donation check, minus the 3% fee, (payable to Impact Las Vegas) to P.O. Box 15797, Las Vegas NV  89114)

Membership Donation (f paying by credit card -- all shown amounts include 3% processing fee)
If making a monthly payment, divide the total Membership Level amount (i.e., $1030) by the # of months left in the calendar year. Select Other and enter this amount in the Other Amount field.
If "Other" please fill in Other Amount
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Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

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