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.

If you wish to pay in installments (monthly or quarterly), or make a pledge (a promise to pay at a later date), please call the Town of Palm Beach United Way at 561-655-1919 – they will be happy to assist you.

Please also call the United Way office if you are paying through a private foundation or donor advised fund.

Membership *

Annual Membership ($1,100 is tax deductible) - $ 1,100.00

Total Amount

Personal Information

Title

First Name *

Last Name *

Email Address *

Street Address *

City *

State *

Postal Code *

Country

Company

Phone

Please publish my/our name(s) as

I was referred by

This gift is in honor of

This gift is in memory of

Credit Card Information

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Card Number

Security Code

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

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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