Prisma Health-Upstate Foundation :: Legacy Society Membership Form

Legacy Society Membership Form

Prisma Health-Upstate Foundation
Welcome to the Prisma Health-Upstate Foundation Legacy Society. Please take a moment to complete this membership form so we may recognize your generosity as you intend and affirm your membership in the Prisma Health Legacy Society.
Name

First NameLast Name
Birthdate

MonthDayYear
Date
Name

First NameLast Name
Birthdate

MonthDayYear
Date
Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Prisma Health–Upstate Foundation may publish my/our name(s) as a member of the Legacy Society or in other publications and donor listings.

YesNo
If above question is yes, I/We would like our name(s) to appear as follows
I/we wish that my/our estate commitment remain anonymous.

YesNo
Name of your estate planning advisor
Donor Signature

Clear
Date: Date
Donor Signature

Clear
Donor name: Date: Date
The Prisma Health-Upstate Foundation is the fundraising arm of Prisma Health–Upstate. Our purpose is to serve the private giving needs of the health system by raising and managing private gifts, then directing those funds and assets according to each donor’s intention. We connect donors with their passion for transforming health care in the Upstate, all in support of Prisma Health’s purpose:

Inspire health. Serve with compassion. Be the difference.

Prisma Health-Upstate tax identification number is: 93-2009608
Prisma Health-Upstate Foundation CONFIDENTIAL DOCUMENT
300 E. McBee Avenue
Suite 401
Greenville, SC 29601
Phone 864 797-7746
Fax 864 797-7705
Email Giving@PrismaHealth.org
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