THE PSA LEGACY FELLOWSHIP

PHYCOLOGICAL SOCIETY OF AMERICA LEGACY FELLOWSHIP REGISTRATION FORM
Welcome to the Legacy Fellowship of the Phycological Society of America! We appreciate your inclusion of the Society as part of a philanthropic component to your estate plan, or your plan for transfer of required minimum distribution of pre-tax savings during your lifetime. While completion of this form will enroll you in the Fellowship, the Society would appreciate receiving more details of your planned giving if you are willing to share them. Please contact the Fund Manager to create a secure method for sharing this information. If you intend to make a direct transfer of a required distribution from a pre-tax savings account during your lifetime, please contact the Fund Manager. If you have more than two donors, please also contact the Fund Manager.
As evidence of a desire to promote and sustain the scientific and educational work of the Phycological Society of America, I/we hereby inform you of my/our intent to make a gift in my/our estate plan and/or through direct transfer from tax-free savings plans during my/our lifetime.
Donor 1

First NameLast Name
E-mail of Donor 1
Donor 2 (if applicable)

First NameLast Name
E-mail of Donor 2 (if applicable)
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number

I/We would like to join the Legacy Fellowship of the Phycological Society of America by (check all that apply):
Upon registration, you will receive a lapel pin that can be worn to PSA functions in order to identify you as a Legacy Fellow of the Society and to spark conversation about planned giving. You will also receive a letter acknowledging your membership in the Legacy Fellowship. If you would like a printed certificate or plaque for display, please indicate your preference below.
PUBLICITY:From time to time the Society may publish lists of Legacy Fellowship members to encourage others to consider this form of planned giving, to recognize the generosity of our Legacy Fellows, and/or to encourage Legacy Fellows to socialize or meet with each other. Please indicate below if you do not want to have your name shared in either of these ways.
OPTIONAL BIOGRAPHICAL INFORMATION – Please share any biographical information you would like us to have for potential use upon receipt of your gift or in other publicity. For joint donors, please include biographical information of both donors here.
OPTIONAL GIFT COMMENTARY - Please share any thoughts about the Phycological Society, that relate to your gift that could be included in publicity at the time the gift is received.
OPTIONAL GIFT INCORPORATION - Please share any preference you may have about how you would like your gift to be incorporated into the Endowment.
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PHYCOLOGICAL SOCIETY OF AMERICA LEGACY FELLOWSHIP REGISTRATION FORM