Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.District # *District 1District 2District 3District 4Regional Group Name *Cape Cod & Islands Regional GroupCarolina Regional GroupMid-Atlantic Regional GroupNew Hampshire Regional GroupNew Jersey Regional GroupNew York Regional GroupPennsylvania Regional GroupRhode Island & Southeastern Massachusetts Regional GroupRegional Group Name *Captain Buddy Spivey Razorback (Arkansas) Regional GroupForward Wisconsin Regional GroupHeartland Regional GroupIllinois Regional GroupIndiana Regional GroupLouisiana / Mississippi Regional GroupMichigan Regional GroupMidwest North Regional GroupOhio Regional GroupOklahoma Regional GroupTennessee Regional GroupRegional Group Name *Alabama Regional GroupEmerald Coast Regional GroupFlorida Regional GroupGeorgia Regional GroupRegional Group Name *Charles Register Regional GroupGEM State Regional GroupGreater Houston Regional GroupNew Mexico Regional GroupRocky Mountain Regional GroupSan Diego Regional GroupSouth Texas Regional GroupSouthern California Regional GroupSouthern Nevada Regional GroupSpokane Inland Empire Regional GroupUtah Regional GroupWashington Regional Group Bank Bank Name *Account Number *Routing Number * Add Bank Remove Last Bank Do you have an investment fund? *YesNoInvestment Fund Institution Name *Account Number *Do you have Certificates of Deposit (CDs)? *YesNoNumber of CDs *Combined Value of CDs *Employer Identification Number (EIN) *Date Annual IRS Report Filed *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Beginning Total Regional Group Balance (July 1, 2023) *RevenueAnnual Apportionment Revenue (total received during this fiscal year) *Donation Revenue (total received during this fiscal year) *Fundraising Revenue (total received during this fiscal year) *Other Revenue (total received during this fiscal year) *Total Revenue *ExpensesConvention Expenses (total) *Programs / Banquets / Events Expenses (total) *Fundraising Expenses (total) *Administrative Expenses (total) *Other Expenses (total) *Total Expenses *Ending Balance *Additional DetailsPlease provide additional details as necessary.Upload copies of financial institution documents reflecting ending balances Click or drag files to this area to upload. You can upload up to 6 files. Officer Signature *Officer Email *Submit
