This page may not work correctly in your current browser, Internet Explorer. We recommend changing to a more modern browser before viewing this page. We recommend Chrome, Firefox, Safari, or Edge. Membership Enrollment Join Us! If you are paying by check, complete this form and choose "Pay Later" at checkout. First Name: Last Name: Mailing Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix Email: Cell Phone: Alternate Phone: In an effort to provide better Networking Opportunities, we ask that you provide your Employer and Job Title. Employer: Occupation: Membership Level* NA 2021-22 Membership Impact OK 2022-23 Membership 2023-24 Membership *Desired Membership Level: Committee Interest *Grants - Focus Area Committee (Grant Review) *Grants - 990 Club (Financial Review) Membership - Recruitment Membership - Retention Events Admin Team Where Needed Manage Your Account 1) Login Name: Use your email address or create a unique name 2) Password: Must contains at least eight (8) characters and at least one (1) number Login Name: Password: Retype Password: Use this section to indicate your communication preferences. Preferred Contact Method Postal Mail Electronic Mail Telephone Call Text Message Subscribe Subscribe me to the Impact Oklahoma Newsletter Permission to Publish Impact Oklahoma may list me as a member publicly. Impact Oklahoma MAY NOT list me as a member publicly. Support the work of Impact Oklahoma with a donation in any amount. : $25,000 LIFETIME $1,500 WOMAN OF IMPACT $1,150 MEMBER $575 JUNIOR MEMBER (age 40 and under) Neon CRM by Neon One
