Planned Gift Intention Form

Please submit this form to enroll in The Legacy Society for a Cure. A printable form is available as well. If you have any questions about planned giving or making any other type of philanthropic contribution, please contact Jess Haas, Senior Director of Philanthropic Giving, at jhaas@braintumor.org or 617-924-9997 ext. 8327.

Personal Information

Name:(Required)

First Last

Date of Birth:(Required)

Address:(Required)

Street Address City State ZIP / Postal Code

Phone Number:(Required)

Email:(Required)

Planned Gift Details

As evidence of my/our desire to provide legacy support to the National Brain Tumor Society, I/we have made a provision for a gift in our estate plans.

It is my/our intent to leave a legacy gift to the National Brain Tumor Society through:(Required)

Will

Living/Revocable Trust

Retirement Plan/IRA

Life Insurance Policy Beneficiary

Other

Other type of legacy gift:

What is the specific amount of the gift?

What is the percentage of the residuary of your estate, trust, or retirement plan?

This gift in honor of or in memory of:

Purpose

Please designate our gift to the following:(Required)

Unrestricted to support the overall mission of NBTS

This gift is for the NBTS endowment

This gift is to support research

Would you like to have your names published as part of The Legacy Society for a Cure?(Required)

If yes, please list how you would like your name(s) to be displayed:

All information provided will be kept confidential. Please discuss your planned giving intentions with your professional financial and legal advisors. NBTS is a tax-exempt nonprofit organization recognized by section 501(c)3 of the Internal Revenue Code. Contributions are tax-deductible to the extent permitted by law.

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