Membership Application

Enclosed is my annual dues check in the amount noted for the type of membership I've indicated below:

qNon-Profit	75.00	(regular organization fee less BWF sponsorship of $175.00)
qIndividual	100.00		qGold	500.00
qFamily	150.00		qSapphire	1000.00
qBusiness/Organization	250.00		qDiamond	5,000.00

New members will receive one lapel pin designating his/her type of membership. An additional Family pin is available at cost.

Business/Organization	_____________________________________________________________________________
Contact	_____________________________________________________________________________
Individual Member(s) Name	_____________________________________________________________________________
Please describe your Business/Organization or Yourself	_____________________________________________________________________________
	_____________________________________________________________________________
Address	_____________________________________________________________________________
City, State, Zip	_____________________________________________________________________________
Phone	_________________________	Fax_______________________	Cell________________
Email Address	_____________________________________________________________________________
Website	_____________________________________________________________________________

Please include me on your mailing list for:

qFoundation Newsletter qMonthly Breakfast Meeting Reminder via Email/Mail qPlanned Giving Information

M Y P L E D G E S T O T H E F O U N D A T I O N

I would like to participate in Foundation activities by:

qSimply being a Member and - qby volunteering my time as noted in item 6. below

and - qby making an additional financial donation as follows:

Dreams for Kids $__________ Basin Wide Foundation's General Fund $__________

BrehmYouth Sports Park $__________

I would like to meet with a Board Member and Estate Planner to discuss a planned Giving Program q

I would like to participate in - or have expertise in - the following area(s):

qFundraising qInvestments q Public/Private Partnerships

qGrant Writing qReal Estate q Non-profit Management

qStrategic Planning qNewsletter qLaw

qFinancial Planning qPublicity qComputer Applications

qEstate Planning/Endowments qPublic Speaking qOffice Help

qMarketing qCultural Arts qOther____________

qMembership qNominating

Standards of Conduct

A signed application for membership in the Basin Wide Foundation constitutes consent by the applicant to adhere to the by-laws; to execute one's position with the Foundation in an ethical and legal manner that is not unbecoming or prejudicial to the to the aims or repute of the Basin Wide Foundation. A member can be expelled for conduct unbecoming a member of this organization. Each member - regardless of type - has equal voting or other rights. No individual or organization shall hold more than one membership.

My Signature________________________________________________ Date___________________

Return this Application with a check for your first years dues to the address noted above. Applications are subject to approval by the BWF Board of Directors. If membership is not forthcoming, your check will be returned.
Federal tax information: The Basin Wide Foundation is a non-profit public benefit corporation under the Nonprofit Public Benefit Law for Public and Charitable purposed within the meaning of Section 501C3 of the Internal Revenue Code. Dues may be considered a charitable tax deduction for federal tax purposes. Our Federal Tax ID number is 33-0688147. Consult with your tax advisor for additional details.