Foundation Nautilus Membership

Nautilus Membership

Leaving a Legacy
If you need any assistance with this form or have questions, please call our Foundation office at 720-974-2224
Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Spouse/Partner if applicable

First NameLast Name
Spouse/Partner Birth Date

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Please use the following language to identify the Mile Hi Church Foundation in your bequest or beneficiary designation:

MILE HI CHURCH FOUNDATION, a Colorado Non-Profit Corporation, currently located at:
9077 West Alameda Avenue, Lakewood, Colorado 80226
Federal Tax ID Number 84-0919606.
It is my/our intent to leave a legacy to Mile Hi Church Foundation through my/our: (check all that apply)*

WillLiving TrustRetirement AssetsCharitable Remainder TrustLife Insurance PolicyOther
I/we wish to inform Mile Hi Church Foundation, for long-term endowment planning purposes only, that as of this date, the value of my/our gift is:

(If you are not comfortable with completing this item, please type NA in the Dollar Amount)
Dollar Amount: $
Percentage of Estate:
I/we understand that, by stating an amount, my/our estate is not legally bound by this statement and I may choose to add, subtract, or revoke this bequest at any time, at my/our sole discretion.
By signing below I/We confirm that I have completed all legal documents necessary to ensure that my gift will be conveyed to the Mile Hi Church Foundation.
Signature:*

Clear
Date:*

MonthDayYear
Date
Spouse/Partner Signature:

Clear
Date

MonthDayYear
Date
Email*
example@example.com
Anonymity preferences*

Do not wish to be anonymousI wish to remain anonymous during my lifetimeI wish to remain anonymous both before and after transitionAfter my transition, please consult with my family, including a life partner, about whether my gift should remain anonymous
If the Foundation will receive your gift following another person's use or interest, please provide the names and phone:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
If a financial institution will be involved in implementing your gift, please provide the following:
Name:
Capacity:
Contact:
Phone Number
Please enter a valid phone number.
Personal contact(s) below: (e.g., attorney, trustee, personal representative, child, sibling, trusted friend):
Name:
Relationship:
Name:
Relationship:
I/we wish to allocate all or a portion of our endowment donation to the following “Foundation Pillar of Giving”:

InfrastructureYouthEducationOutreachBest use
NAUTILUS DONOR WALL NAMEPLATE

As a Nautilus member, a nameplate with your name will be added to the Donor wall in the Sanctuary lobby. Please provide your name(s) as you wish it to appear on your nameplate.
Enter your name(s):
Check here if you do not wish to have a Nameplate

No Nameplate
Personalized Quotation or Message

There is space on your Donor Wall nameplate to include a brief one or two line quotation or verse from a favorite author or poet, or compose your own inspirational message about prosperity, circulation, immortality, or a spiritual topic with personal meaning. (Space limit is 80 characters.)
Enter your Quotation or Message:

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