Legacy Society Member Profile

Please fill out the form below to send us your member profile to be included into Legacy Society.

* Indicates a required field

Prefix
First Name: *	MI
Last Name: *
Address: *
City/State/Zip: *
Telephone:
E-Mail: *

Please check one:
	The American Red Cross may include my (and, if applicable, my spouse's) name in Legacy Society listings. (Neither amount nor designation, if provided, will be included on the listing.) Please list me / us as follows:
	I am honored to be included in Legacy Society, however I prefer to remain anonymous. Please do not include my/our name in Legacy Society listings.

The following information is optional:

Please tell us more about your estate provision for the American Red Cross.

I have named the American Red Cross as a beneficiary of my:

	Will/trust for: a specified amount a specified percentage		Life Insurance Policy
			Charitable trust as remainderman
	IRA or retirement plan
	Other (please specify):

My gift is:

Unrestricted

Designated for:

Estimated current value

as of (date)