The Legacy Society

Please enroll me/us as a member(s) of The Legacy Society

Name

Address Line 1

Address Line 2

City

State

Zip

Day Phone

Evening Phone

Email

Date

Recognition

Recognition -- Please Choose -- I/We prefer to remain anonymous. You may include my/our name(s) in the Legacy Society Honor Roll

Name(s) as it/they should appear in recognition materials

Contribution to an Endowment for The Phipps Center for the Arts

Amount to be given in $

Gift made in the form of -- Please Choose -- Cash Appreciated Securities Other (Specify Below)

Other Type Of Gift

Beneficiary

I/We have designated The Phipps Center for the Arts as a beneficiary of:

A will or revocable living trust.

A life insurance policy

A charitable remainder trust

A charitable lead trust

A 401K, IRA or qualified pan

A charitable gift annunity

Other

To assist The Phipps in its planning, if you are willing, please indicate the approximate value of your gift: $

Please be assured that the information provided on this form will remain confidential. This statement indicates your intentions; should it be necessary to change your plans, please notify the executive director of The Phipps of any changes so that our records may be updated. An acknowledgement of this form will be sent to you for your records.

The Board of Directors greatly appreciates your generous commitment to this center for all the arts.