ABPsa Legacy Partners Intention Form

Legacy Intention Form

Thank you for including the American Board of Psychoanalysis in your estate plan and for ensuring standards for psychoanalysis. The information you provide here will allow us to provide the best possible stewardship of your gift. This is not a binding legal document, and your information will be kept confidential. Share whatever information you would like.

Please contact Denise Wagner at 303-676-8008 if you have any questions.

It is my/our pleasure to inform you that we have made a provision for a gift to the ABPsa in our estate plans. It is my/our intent to leave a legacy gift to the ABPsa through a (please check all that apply)

Published preference

If answered yes above, how would you like your name to appear:

If you wish, please use this space to share additional details about this gift.

I/we understand that my/our estate(s) are not legally bound by this statement and I/we may choose to add to, subtract from, or revoke my/our legacy gift at any time, at my/our sole discretion. (The ABPsa kindly requests notification of revocation.)

Name

Address

Email

example@example.com

Phone

Format: (000) 000-0000.

Signature

To sign electronically, either press and hold your mouse while signing your name, or use a touchpad.

Today’s Date

Date

American Board of Psychoanalysis
501 S. Cherry Street, Suite 1100 Denver, CO 80246
(303) 676-8008 | info@abpsa.org

Current Contact Information