APPLICATION FOR NATIONAL RECOGNITION OF LOCAL COUNCIL ENDOWMENT GIFTS
Allegheny Highlands Council , BSA; 50 Hough Hill Road, Falconer, NY 14733
(For Council Files)

Please give this form (and attach to your gift, if applicable) directly to your local council.

Name(s) :(to appear on certificate) ___________________________________________________

Company: (if applicable) _______________________________________________

Mailing Address: _______________________________________________

City/State/ZIP: _______________________________________________

Phone: ____________________

___ I would like more information about: _________________________________________

___ I would like to make a gift that qualifies for membership in (please check one):

_____ James E. West Fellowship Program

$1,000 or more in cash or marketable securities to a local council endowment fund*

_____ The 1910 Society

$25,000 or more, outright or in a pledge payable within five years, to a local council endowment fund

Four Giving Levels: Ernest Thompson Seton Member -- $25,000 minimum

Daniel Carter Beard Member -- $100,000 minimum

Theodore Roosevelt Member -- $500,000 minimum

Waite Phillips Member -- $1,000,000 minimum

_____ The Founders Circle

$100,000 or more in the form of a deferred gift commitment to a council endowment fund

Four Giving Levels: Bronze Member -- $100,000 minimum

Silver Member -- $250,000 minimum

Gold Member -- $500,000 minimum

Platinum Member -- $1,000,000 minimum

VALUE OF QUALIFYING GIFT: $ _________________________________

DESCRIPTION OF QUALIFYING GIFT:______________________________________________

Name of Donor (if different than above) ______________________________________________________

This gift is: ___ Anonymous ___ In Honor of ___ In Memory Of

GIFT PLEDGE (For 1910 Membership Only)

In consideration of membership in the 1910 Society, and of the pledges of others, I hereby agree to give the endowment fund of the __________________________ Council, BSA,

located in ___________________________, a gift of $ ____________________, to be paid no later than the end of calendar year _______. I recognize that the Council will rely on

my gift in securing pledges of others and in any future financial commitments for programs and projects related to Scouting.

Signed: ______________________________ Dated: _________________________________


* For the West Fellowship, only one name may be listed on the certificate for the minimum gift. A Fellowship in the name of "Mr. and Mrs....", for example, would require a $2,000 minimum gift.