Cancer Support Community of Greater Ann Arbor
IRA Giving Circle Membership Form
If more than one person is designating this gift, please list all donors.
First Name
Last Name
and
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please print your name(s) as you would want it/them to appear on the Cancer Support Community of Greater Ann Arbor's IRA Giving Circle membership listing: (if Anonymous, please note)
Unrestricted gifts are most valuable to CSC because they allow the organization to allocate funds to wherever the need is greatest; however, if there is a particular area that you would like your gift to support, please indicate below:
Unrestricted
Programs
The Brides Project
Sprout Love Financial Assitance Fund
Long Term Opporunity Fund
Other
CSC understands that this confirmation is not legally binding and may be adjusted at any point by the designee.
Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: