MyImpactPage - Application Form

Over the age of 18

By submitting this form you are confirming that you are at least 18 years of age and certify that the information on this form is true.

I am new to MyImpactPage.com

You will need to enter a unique username to identify yourself to the system. You should select something that is easy for you to remember such as your email address or your name. Your username must be at least 6 characters long. If the name you enter is already in use by someone else, you will be prompted to choose another username.

Username

Required

	Username must not start with space
	Username must not end with space
	Username must not have two or more spaces in a row

Email Address

Required

Verify Email Address

Required

I acknowledge the information is accurate Required

I already have a username

If you have signed up with this organization before, or are a member of another organization that uses MyImpactPage.com, you can use the same login to access all organizations with which you are associated.

Username	Required
Password	Required
Forgot your username or password?
I acknowledge the information is accurate Required

Already use MyImpactPage.com to volunteer with this organization? Go to volunteer login

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Application Form - Ruff Start Rescue

Over the age of 18

I am new to MyImpactPage.com

I already have a username