New Endowment Account Form

Date:

Team Information:

Team Name (as it will be listed on our website):

Team Address:

Do You Have a Separate Shooting Team Checking Account?

Yes No

Attach W-9:

W-9 Entity Name:

What type of non-profit is your W-9 entity?

Active Shooting Team Disciplines (check all that apply):

Air Rifle

Air Pistol

Pistol

Smallbore

Shotgun

Highpower

Blackpowder

How many active members are on the team?

Contact Information (One contact should be a board member)

Primary Contact Name:

Relationship to Team:

Primary Contact Address:

Primary Contact Email:

Primary Contact Phone:

Secondary Contact Name:

Relationship to Team:

Secondary Contact Address:

Secondary Contact Email:

Secondary Contact Phone:

Additional Information:

Team Website and/or Facebook Page: (if applicable)

Referred by: (list team or group)

By signing below, I confirm the following:
1. All information submitted is correct to the best of my knowledge.
2. My team is in compliance with the four team requirements listed on the MidwayUSA Foundation website http://midwayusafoundation.org/start-your-account.
3. All endowed funds are the sole property of the MidwayUSA Foundation and grants from my team's account are not guaranteed.

Full Name:

Please Sign Your Name Above With a Mouse or Stylus

If you are having problems submitting the form above, click here to download the PDF version.