Registration Application For A Professional Fundraising Counsel Form Page 2
Download a blank fillable Registration Application For A Professional Fundraising Counsel Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Registration Application For A Professional Fundraising Counsel Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
25.
Please provide a list of all current officers and directors, along with their addresses and phone numbers.
6.
Please provide a list of all officers, directors, individual owners or partners for the preceding three years.
7.
Please provide a list of all employees, their job titles, and whether full time, part-time, or contracted.
8.
Please attach a list of all charitable organizations with which you have contracted in the State of South Carolina for
the previous three years.
9.
Are you currently registered in any other state as a Professional Fundraiser, Professional Solicitor, or a Professional
Fundraising Counsel? ____No ____ Yes If yes, provide a list of all states where registered.
10. Do you ever have custody of contributions or any financial records of contributions of the charitable organization with
which you are contracted?____No ____ Yes If yes, provide a list of individuals who serve as couriers or employees
to personally collect contributed funds from solicited parties.
11. Is any principal officer, director, owner or partner of the applicant also an officer, director, board member, shareholder,
owner or partner of any nonprofit or charitable organization? ____No ____ Yes If yes, provide a full description.
12. Has the applicant, or its directors, principal officers, individual owners, or partners been the subject of a legal or
administrative action, including an injunction concerning a charitable solicitation, fundraising campaign, or campaign
with a commercial co-venturer by another local, state, or federal governmental authority including, but not limited to
registration or license revocation or denial, fines, injunctions, suspensions, or voluntary agreement to discontinue any
charitable solicitation activity? ____No ____ Yes If yes, provide a full description.
13. Has the applicant, or its directors, principal officers, individual owners, or partners been the subject of a criminal
conviction, including guilty or nolo contendere pleas, involving any charitable solicitations act, fraud, dishonesty, or
false statement, forgery, or theft, including identity theft, in a jurisdiction within the United States? ____No ____ Yes
If yes, provide a full description and the date of any such conviction.
14. Are any of the officers, directors, trustees, or board members of the professional fundraising counsel applicant related to
each other? ____No ____ Yes If yes, provide a full description.
15. Are any of the officers, directors, trustees, or board members of the professional fundraising counsel applicant related to
any director, agent, or employee of a charitable organization under contract with the professional fundraising counsel?
____No ____ Yes If yes, provide a full description.
I certify that the information furnished in this application and all attached supplementary information is true and correct to
the best of my knowledge, information and belief. I understand that the giving of false or incorrect information may
constitute a misdemeanor carrying a penalty upon conviction of a fine of not more than two thousand dollars ($2,000.00) or
imprisonment for not more than one year, or both, for a first offense. A second or subsequent offense may constitute a
felony carrying a penalty upon conviction of a fine of not more than five thousand dollars ($5,000.00) or imprisonment of
not more than five years, or both.
CHIEF FINANCIAL OFFICER / TREASURER
CHIEF EXECUTIVE OFFICER / PRESIDENT
_________________________________________
_________________________________________
Print Name
Print Name
_________________________________________
_________________________________________
Signature
Date
Signature
Date
_________________________________________
_________________________________________
Mailing Address
Mailing Address
_________________________________________
_________________________________________
City, State, Zip
City, State, Zip
_________________________________________
_________________________________________
Phone Number
Phone Number
Registration Application, PFR Counsel, revised September 2015
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal