Enrollment Form
Heritage Club members make a gift of $5,000 or more (per person) now or through a gift of a similar amount through their will or trust. Annual installments of $1,000 also may be given. Gifts can be check, credit card, or stock transfer. See your financial planner for ways to ensure your donation does the most good for you and for the future of Kaweah Health.
Name of Member #1
*
Phone Number of Member #1
Birthday of Member #1
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Month
-
Day
Year
Name of Member #2
Phone Number of Member #2
.
Birthday of Member #2
-
Month
-
Day
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
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Heritage Club Membership
$5,000 or more per person
Options
*
I/We have named Kaweah Health Foundation as beneficiary of my/our TRUST/WILL for:
I/We have named Kaweah Health Foundation as beneficiary of my/our INVESTMENT ACCOUNT in the amount of:
I/We prefer to make my Heritage Club gift to the Endowment Fund now (or by end of the year).
I/We prefer to make a 5 year pledge of $1,000 per year (per person).
Amount:
If INVESTMENT ACCOUNT option is selected, please complete the following information.
Name of Company
Name of Company
Representative (if applicable)
Policy Number (if applicable):
Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Phone Number
Please enter a valid phone number.
Submit
Should be Empty: