Board Gift Registration Form

BOARD GIFT REGISTRATION FORM

Submission Date:

RECITALS

WHEREAS, Organization Name: , is a nonprofit/corporate entity that maintains records of gifts and pledges presented to the Board for the purpose of appropriate acceptance, recording, and compliance with applicable policies and law;

WHEREAS, Donor: , desires to register the gift described below and to provide necessary information to permit lawful acceptance and stewardship;

WHEREAS, Recipient/Board Member: , is identified as the intended recipient or liaison for purposes of recording, acknowledgement, and compliance with conflict-of-interest and gift policy.

GIFT DETAILS

Monetary In-kind Pledge Securities/Stock Real Property Other

Yes No

SCOPE OF WORK

(Complete if the gift includes services, deliverables, or performance obligations.)

PAYMENT TERMS (FOR PLEDGES)

Late fee to apply to past-due installment: . If payments are not made in accordance with the payment schedule, the Organization may deem the pledge in default and take any remedy permitted under law or policy, including suspension of recognition or requiring repayment.

TERM AND TERMINATION

Start Date:    End Date (if applicable):

Notice Period for termination by either party: days. Either party may terminate obligations under this registration for material breach, failure to perform, or as otherwise provided in applicable policy; termination will not relieve accrued obligations nor impact rights relating to accepted, irrevocable gifts.

CONFIDENTIALITY

The parties acknowledge that confidential information, as defined by Organization policy and applicable law, may be exchanged in connection with this gift. Each party agrees to treat such information as confidential and not to disclose it except as required by law or as necessary to fulfill the purposes of the gift. The Donor and the Organization further agree that donor identity and gift amount may be made public only with the Donor's prior written consent, except where disclosure is required by law or organizational policy.

CONFLICT OF INTEREST / CERTIFICATION

Donor certifies that the information supplied is true and correct to the best of Donor's knowledge, that the Donor is authorized to make this gift, and that no goods, services or direct benefits were exchanged as consideration for this gift other than those explicitly described herein. Donor must disclose any existing or potential conflicts of interest with the Organization or Board members at the time of registration.

GOVERNING LAW

This registration and any obligations arising hereunder shall be governed by and construed in accordance with the laws of the jurisdiction: , without regard to conflict of laws principles.

ENTIRE AGREEMENT

This registration, together with any written attachments or schedules expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, representations and warranties, both written and oral. Any amendment must be in writing and signed by both parties.

APPROVAL & RECORDS

Appraisal Bill of Sale Valuation Documentation Other

DONOR CERTIFICATION

By signing below, Donor certifies that the information contained in this registration is true and complete, that the Donor has the authority to make the gift described, and that any pledged payments will be made in accordance with the payment schedule. Donor acknowledges that acceptance of the gift is subject to the Organization's gift acceptance policy and applicable law.

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