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

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 below (click on Membership 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.

$1030.00
$515.00 (if making 2 payments)
$257.50 (if making 4 payments)
Other (enter $ amount)
$1,133 Member Plus
$1,236 Supporting Member
$1,545 Supporting Gold Member
$2,060 Supporting Premier Member

If "Other" please fill in Other Amount

Other Amount

Please enter amount

First Name (Required)

Last Name (Required)

Email (Required)

Street Address (Required)

Street Address

City, State, Zip (Required)

City, State, Zip

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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 4th of every following month.

Make this a monthly payment?

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Join!

How To Help