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Full Name / Entity Name*

First NameLast Name

Date of Birth / Incorporation Date*

Date

Address*

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

City*

State/Province*

Zip / Postal Code*

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Government-issued ID / EIN Upload*

Country of Citizenship / Residency*

Membership Status Confirmation*

MemberNon-member

Declaration of Compliance with Membership Requirements*

I confirm I meet the criteria for accredited investor.I confirm I meet the criteria for nonprofit membership.

Optional Investment Experience

Experience in securities investmentExperience in blockchain or tokensExperience in nonprofit funding

Understanding of SEC Regulation D Private Placement*

I understand this is a private placement under SEC Regulation D.

Returns Tied to Nonprofit's QGI Bond Portfolio*

I acknowledge that returns are linked to the nonprofit's QGI bond portfolio.

Number of Tokens/Notes to Allocate*

Pro-rata Rights Included*

I understand I am entitled to pro-rata rights in the allocation.

Acknowledgment that Instrument Does Not Represent Ownership*

I acknowledge that this instrument does not confer ownership rights.

Authorization for Identity Verification and AML/KYC Compliance*

I authorize SNAP to verify my identity and perform AML/KYC checks.

Acknowledgment of Potential Tax Implications*

I acknowledge that participating may have tax implications.

Signature (Digital)*

First NameLast Name

Date of Signature*

Date

Upload Government-issued ID/EIN Document*

SNAP Organization Registration Form 1-A