Impact Las Vegas Foundation, Inc. : How To Help : Join

JOIN NOW!

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 check (payable to Impact Las Vegas) to P.O. Box 15797, Las Vegas NV 89114)

Online Membership Commitment Form

Membership Donation

If making a monthly payment, divide $1000 by the # of months left in the calendar year + add 3% for processing. Select Other and enter this amount in the Other Amount field.

$1030.00
$515.00
$257.50
Other

If "Other" please fill in Other Amount

Other Amount

Please enter amount

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First Name (Required)

Last Name (Required)

Email (Required)

Street Address (Required)

Street Address

City, State, Zip (Required)

City, State, Zip

Preferred Contact Number

Preferred Phone Contact #

Select a Payment Method

Credit Card
Bank Account

Cardholder Name (Required)

Credit Card # (Required)

Visa MasterCard American Express Discover

Expiration Date (Required)

Security Code (Required)

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.

Billing Zip Code (Required)

Account Holder

First Name

Last Name

Account Type

Checking
Savings

Account Number (Required)

Routing Number (Required)

Make this a monthly payment?

Yes, bill my card today and on the 3rd of every following month.

Make this a monthly payment?

Your total payment will be

Membership Commitment Form

OR download this form, fill it out, and mail to our office along with your payment.

Join!

How To Help

Online Membership Commitment Form