Make an IMPACT

Thank you for helping power positive change in our community. To complete your membership for Impact the Palm Beaches, please fill out the form below hosted by our fiscal agent and community partner, the Town of Palm Beach United Way.

Membership *

Annual Membership - $ 1,100.00

Quarterly - $ 275.00

Other - $ 0.00

Other

Total Amount

I want to contribute this amount every month(s) for installments

Your recurring contribution will be processed automatically. You can specify the number of installments, or you can leave the number of installments blank if you want to make an open-ended commitment. In either case, you can choose to cancel at any time. You will receive an email receipt for each recurring contribution.

Personal Information

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First Name *

Last Name *

Email Address *

Street Address *

City *

State *

Postal Code *

Country

Company

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I was referred by

This gift is in honor of

This gift is in memory of

Credit Card Information

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THE TOWN OF PALM BEACH UNITED WAY MEETS ALL REQUIREMENTS SPECIFIED BY THE FLORIDA SOLICITATION OF CONTRIBUTIONS ACT. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL FREE WITHIN THE STATE (1-800-435-7352). REGISTRATION DOES NOT IMPLY ENDORESEMENT, APPROVAL OR RECOMMENDATIONS BY THE STATE. FLORIDA REGISTRATION NUMBER 710843, FEDERAL ID NUMBER 59-063-7885. THE TOWN OF PALM BEACH UNITED WAY RECEIVES 100% OF EACH CONTRIBUTION. THIS INFORMATION WILL BE USED ONLY BY THE TOWN OF PALM BEACH UNITED WAY AND WILL NOT BE DISCLOSED TO OTHER PARTIES.

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Make an IMPACT