ARLIS/NA Gift Planning Statement of Future Gift Intent

ARLIS/NA Gift Planning Statement of Future Gift Intent
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Significant Other's Name

First NameLast Name
Significant Other's Date of Birth

MonthDayYear
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Email Address*
example@example.com
Name of Your Attorney, Trust Administrator or Next of Kin*

First NameLast Name
Phone Number for Your Attorney, Trust Administrator or Next of Kin
Please enter a valid phone number.Format: (000) 000-0000.
Email Address for Attorney, Trust Administrator or Next of Kin*
example@example.com
I/we have made provision(s) for the Art Libraries of North America in the following manner:
Source of the Gift*

Will or Revocable TrustCharitable TrustIRA, Retirement, or Investment AccountLife Insurance PolicyBank Account (Payment on Death)Other
If Other selected, please explain:
Bequest Type*

Percentage of valueSpecific amount
List specified amount (either the percentage or dollar amount in USD)*
Purpose of Future Gift:*

Unrestricted Gift to the SocietyUnrestricted Gift to the ARLIS/NA Annual Conference$50K for 50 Years FundConference Speakers FundConference Speakers of Color FundInternship FundIRC Study Tour Scholarship FundTravel Grant FundOther
If other, indicate the designated purpose of the funds. Note, if at any time, in the judgment of the Executive Board of the Art Libraries Society of North America, the designated use of this bequest is no longer practicable or appropriate, then the Executive Board, in its discretion, shall use the bequest to further the general purposes of the Society, giving consideration, where possible, to my special interests as described below.
Today's estimated value of my/our future gift to ARLIS/NA is approximately
$ blanks

However, I/we understand that future fluctuations/changes in the market/economy may have an impact on this value. It is understood that the statement of intent is revocable and not legally binding on my/our estate. All information will be kept confidential. The gift amount or the current estimated value of my/our gift will be used for recognition purposes only.
Signature
Date

MonthDayYear
Date
Signature
Date

MonthDayYear
Date
ARLIS/NA may use my/our name(s) and gift details to inspire others to givePlease keep my/our gift amount anonymous
Should be Empty: