STATE OF WEST VIRGINIA PROFESSIONAL FUND-RAISING COUNSEL=S AND/OR PROFESSIONAL SOLICITOR=S BOND SECRETARY OF STATE 1900 KANAWHA BLVD., SUITE 157-K CHARLESTON, WV 25305-0770 BOND NUMBER_____________________________ KNOW ALL MEN BY THESE PRESENTS: THAT (Name of Individual, Partnership or Corporation) ___________________________________________________ of (Address) ________________________________________________________________________________________ as Principal, and ___________________________,of(Address)_______________________________________________ _______________________________________, as Surety. Are held and firmly bound unto the State of West Virginia for the use of the Secretary of State, and to any person who may have a cause of action against the Principal for any losses resulting from malfeasance, nonfeasance or misfeasance, in the conduct of solicitation activities, in the sum of TEN THOUSAND DOLLARS ($10,000), lawful money for use of the Secretary of State, and to any person who may have a cause of action against the Principal for any such losses, as their interests may appear, not exceeding in the aggregate the said sum of TEN THOUSAND DOLLARS ($10,000) for which payment will and truly be made we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally by these presents. WHEREAS, the above bound Principal has applied to the Secretary of State of the State of West Virginia for registration as a Professional Fund-Raising Counsel or Professional Solicitor for a charitable organization pursuant to West Virginia Code ' 29-19-9, as amended. NOW, the condition of this obligation is such, That if the Secretary of State shall register the above bound Principal as such Professional Fund-Raising Counsel or Professional Solicitor and said Principal shall faithfully and honestly act as such Professional FundRaising Counsel or Professional Solicitor in accordance with law, and fully complies with the provisions of Chapter 29, Article 19 of the West Virginia Code, as amended; and if the Principal shall fully indemnify and save harmless from loss the State of West Virginia and any person who may have a cause of action against the Principal for any losses resulting from malfeasance, nonfeasance or misfeasance, in the conduct of solicitation activities, then this obligation shall be void; otherwise it will remain in full force and effect. This bond is to cover all claims arising on account of the registration of the Principal and his acting in performance thereof. This bond shall be effective from the_____ day of _____, 20_____. Executed this _____day of ________________________________, (Year) _______. ____________________________________(Corporate Seal) Principal Signature Title: _____________________________ President or Vice- President _______________________________(Corporate Seal) Surety Company _________________________________ Authorized Signature - Surety Company Attach Power of Attorney with raised seal, current as of the execution date. Approved as to Form and Sufficiency of Execution: By ____________________________________________________ Assistant Attorney General American LegalNet, Inc. www.USCourtForms.com