Gift Information

Donation Amount*
  • $5000 Lifetime
  • Other $

Is this membership a gift for another person?

If this membership is a gift for someone else, please fill out the information for the recipient and indicate in the comment box if you would like their membership materials to be sent directly to the recipient or to you (the gift giver). You can also indicate if you would like to be mentioned in the membership letter or if you prefer to remain anonymous. If you have any questions regarding this process, please contact Chelsea Barras at cbarras@100clubchicago.org or at (312) 265-0920.

Contact Information

Company
Job Title
Name on Membership Card
Additional Names on Membership Cards

If you have purchased Gold Level Membership please indicate the three (3) additional names to receive membership cards.

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*
Please be specific?

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code