Name

---

Name:______________________________________________________________________________________ Address:_____________________________________________________________________________________ City / State / Zip Code:_________________________________________________________________________ Phone:______________________________________________________________________________________ Email:______________________________________________________________________________________ r Yes, I plan to transfer funds to the Grand Canyon Council, BSA prior to 12/31/2013 Amount of planned transfer: $_____________________ IRA Institution:_______________________________________________________________________________ Credit my transfer to: r Operating r Capital r Endowment ______________________________________________________________ __________________________ Signature Date