IZAAK WALTON LEAGUE OF AMERICA CHAPTER QUESTIONNAIRE Ple a s e c o m p le t e t h e fo llo w in g s e c t io n s a n d re t u rn t o t h e Na t io n a l Ofc e o f t h e Iz a a k Wa lt o n Le a g u e o f Am e ric a b y n o la t e r t h a n Au g u s t 1 5 t h o f t h is y e a r, a n d in c lu d e t h e fo llo w in g :

I. CHAPTER INFORMATION
IWLA Division Chapter Number: 4 8 - 0 7 5 Chapter Name: Loudoun County Chapter of the Izaak Walton League of America Chapter Mailing Address: Po Box 1338 Leesburg VA 20177 Chapter Telephone: (703) 777-9684 Chapter Web Site: www.loudouniwla.org Current Member Count: 1,000 Date Chapter Was Chartered: March 15, 1951

IRS-Assigned Tax ID Number (Employer ID Number or EIN) 54 - 1253532 If not under IWLA Group 501(c)(3) Group Exemption, Federal Tax-Exempt Status: 501(c)( 3 ) Chapter Fiscal Year Begins in the Month of: January Name and Title of Officer Completing This Form: John McWilliams Address: C/O LCC-IWLA PO Box 1338 Leesburg VA 20177 Phone: Home (703 ) 737 -3122 Work (703) 571-246-2206 Fax (__ __ __ ) ___ ___ __ -___ ___ ___ ___ E-Mail: president@loudouniwla.org

II.

SUMMARY OF CHAPTER ACTIVITIES

In the questions below, we ask you to provide basic information on chapter meetings, publications, activities, and other uses of chapter property. This information is needed to help us determine the extent to which your chapter is supporting the conservation mission of the Izaak Walton League of America and fulfilling its obligations as a tax-exempt organization. In each case, we ask you to estimate approximately how much time your chapter devoted last year to these types of activities. In the case of chapter meetings, publications, and activities, we would like to know whether the primary purpose of an individual activity was for education/conservation; social/recreation; fundraising; or chapter operations. To help you complete this form, here is a list of sample individual activities that would qualify as education/conservation; social/recreation; fundraising; or chapter operations: Education or Conservation Activities: Hunter/angler conservation or safety education programs; firearms training; stream monitoring; litter pick-up events; tree plantings; presentation or articles on conservation topics; testimony at public hearings on conservation issues; providing facilities to schools, scouts, or other youth groups: student scholarships to study conservation; or providing grants to other conservation organizations. Social or Recreation Activities: Dances; games (cards, darts, etc.), barbecues or other meals; shooting sports; hunting; fishing, boating, camping. Fundraising Activities: Auctions; raffles; food sales; membership renewal and recruitment; construction and sale of League items; facility rentals; grant writing and administration. Chapter Operations: Election of chapter leaders; preparation and approval of budgets; review of chapter finances; filing of annual tax returns; maintenance of chapter grounds or buildings.

A.

Chapter Meetings
Number of Meetings per Year: 24 (12 Director & 12 Regular Member Meetings) Please rank from 1 (the greatest amount of time) to 4 (the least amount of time) the approximate amount of time spent at meetings this year on each of the following activities. (Enter n/a for any activity that did not take place at any meetings in the past year.) Chapter Operations: 2 (10hrs) Education/Conservation Activities: 1 (14hrs)

Social/Recreation Activities: N/A B.

Fundraising: N/A

Chapter Publications (such as newsletters and websites)

Please list the publications the chapter has produced in the past year and rank from 1 (the greatest portion of the publication) to 4 (the smallest portion of the publication) the approximate portion of each publication devoted to each of the categories. (Enter n/a for any category not reflected in a publication.) Attach extra sheets if necessary.
(and number of issues if published multiple times in past year)

Publication 4

Rank (1 4 or n/a) Portion Devoted to: Chapter Ops. 2 Educ./Conserv. 1 Social/Recreation 3 Fundraising 4

C.

Chapter Activities
Please briefly describe the types of activities conducted or sponsored by your chapter in the past year. For each activity, please list the number of times each activity took place, e.g. how many days were devoted to the activity. Please indicate whether the primary purpose of the activity was education/conservation; social/recreation; fundraising; or chapter operations. Please attach extra sheets if necessary. Activity
(Education/Conservation; Social/Rec or Fundraising; or

Primary Purpose

(and number of occurrences for activities taking place multiple times in past year)

Outdoor Ethics Banquet x1 Women Enjoying Loudoun Outdoors x1 Youth Hunter Education Challenge (YHEC) x11 Hunter Education, NRA Training, Shooting Sports x26

Chapter Operations) Education/Conservation Education/Conservation Education/Conservation Education/Conservation

D.

Other Uses of Chapter Property

If your chapter owns or leases property, please describe the ways in which you allow chapter members, outside groups, and the general public to use the property not covered above. For each use, please provide an estimate of the degree to which the property is used for that purpose, and state whether the chapter charges a fee for that use. Please attach extra sheets if necessary. Example:
U se o f Pro p e rt y Property open to the public for hiking and bird watching E s t im a t e o f U s e Every weekend except when used for Scout campouts (approximately 40 weekends per year) Fe e ? No

U s e o f Pr o p e r t y Boy & Girl Scouts of America, 4H, and Conservation Clubs Member Group Use

Es t im a t e o f U s e 24 8

Fe e ? No No
Cat hy

P le a s e r e t u r n t h is q u e s t io n n a ir e t o : Iz a a k W a lt o n L e a g u e o f A m e r ic a , A T T N : B e r g e r , 7 0 7 C o n s e r v a t io n L a n e , G a it h e r s b u r g , M D 2 0 8 7 8 - 2 9 8 3

If y o u h a v e a n y q u e s t io n s o r f o r a n e le c t r o n ic c o p y o f t h is f o r m , p le a s e c o n t a c t C a t h y a t ( 3 0 1 ) 5 4 8 - 0 1 5 0 , e x t . 2 2 2 o r c b e r g e r @ iw la . o r g .