Impact Fairfield County Membership Form

As of July 1, 2022, membership in Impact Fairfield County is contingent upon receipt of a $1,100 non-refundable donation and this signed form. This Annual Membership fee includes a $1,000 contribution to our grant funding pool and a $100 donation to help cover our operating costs. Additional contribution options are detailed below in the payment section. Contributions are due by December 31st if you want to participate on a Review Committee to evaluate Impact FFC proposals from nonprofit applicants. (Returning RC members can participate in the early stage of review if membership is renewed by November 15th).

RENEWING MEMBERS: If all your contact information remains the same as last year, you can skip the first section and move on to Section I: Your Information.