Registration

Commitment: With my digital acceptance below, I am agreeing that the information I provide below is accurate and true. I am pledging to participate in 100MenWhoCareRegina and I am making a personal commitment to contribute $400 each calendar year ($100 quarterly) to local nonprofit organizations serving the City of Regina region. I agree to donate each quarter to the nonprofit organization selected by the group’s majority vote. If I am unable to attend a quarterly meeting, I will either send my check with another attending member to deliver on my behalf, mail it as requested after the meeting, or pay online, if that option is presented. I also acknowledge that photographs and videos taken at events and meetings may include my image and may be used in promotional materials for 100MenWhoCareRegina.understand my personal contact information is strictly confidential and I understand it will not be shared or distributed to an outside third party without my expressed consent. If 100MenWhoCareRegina chooses to publish a Membership Directory, I agree that my contact information be included in that directory. *

I agree to be included in the directory
I do not agree to my inclusion in the directory

Name *

First

Last

Best Phone Number to Reach You: *

Email *

Please consider this my acceptance / digital signature.

I am committed to help as outlined above.

(Should you wish to discontinue membership at any time after your four-time commitment, please send an e-mail indicating your withdrawal.)

Download a paper copy of our Registration here:

Registration-Form with logo 100MWCR 2019