Legacy Society Membership Form You must have JavaScript enabled to use this form. Full Name Date of Birth Name of Spouse Spouse's Date of Birth Address City/Town State/Province Zip/Postal Code Telephone Email Yes, I/we have made a provision for Hebrew SeniorLife in my/our estate plan as follows: My/our future gift to Hebrew SeniorLife is from: Bequest intention from Will/Trust IRA/Retirement Account Bank, Brokerage, or Donor-Advised Fund Life Insurance Policy Charitable Gift Annuity Other Date of Estate Planning Document: The estimated value of my/our future gift is: ($ or % of estate) If you would rather share a gift range, please identify your best estimate below: $1-$9,999 $10,000-$49,999 $50,000-$99,999 $100,000-$499,999 $500,000-$999,999 $1,000,000 or more Please use the space below for additional information you would like to share with us about your gift, including the purpose of the gift: I/we would like to be part of the Legacy Society: Yes No I/we want to be included in the donor listings. Yes No Name Please write how you would like your name(s) to appear. I/we would like my/our gift to be anonymous Yes No Status message Thank you for your support. Documentation that further describes the above provision(s) is encouraged. In particular, a copy of the section of your will, trust agreement, or other documents pertaining to Hebrew SeniorLife is appreciated. Having this information on file will help us to fulfill your philanthropic wishes. Please note that all information provided is confidential. These documents can be sent to carolsnow@hsl.harvard.edu or uploaded below. Submit Documentation Here Upload One file only.100 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, csv. Submit Leave this field blank
