Membership Application – Women on Mission St. Louis

I wish to make a non-refundable membership contribution to Women on Mission – St. Louis. All contributions for the current grant year are due by December 31.

Name*
First Last
Email*
Address*
Street Address City State ZIP Code
Home Phone
Work Phone
Mobile Phone
Fax
Referred By
Member*
Memberships are $1,000 for the current year. Members under 40 can join for $500. Please contact Kristy Hutcheson, Director of Scholarships, for potential scholarship opportunities.
Additional Donation

I want to “Give 110%” to support Women on Mission-St. Louis. Add $100 (10%) or other amount.
Total
$0.00
Women on Mission - St. Louis is a non-profit organization exempt from federal taxes under Internal Revenue Service Code 501 (c) (3). All contributions are tax-deductible.
Authorization*
- I understand that any donation beyond my $1000 membership contribution will first be designated to cover administrative costs and, only at the discretion of the Board of Directors, will this money be included in a grant. I grant Women on Mission - St. Louis permission to publish my name in the listing of members contained in the program for the Annual Meeting.

If sending a check, please make checks payable to “Women on Mission- St. Louis.” Send to: 18545 Sassafras Point, Glencoe, MO 63038