Code Blue! The State of Texas Healthcare

Planned Giving Pledge Form
Yes, I am committed to leaving a lasting legacy beyond my lifetime by including The Texas Lyceum Association Inc. (Texas Lyceum) as a beneficiary through my will, life insurance, and/or retirement plan. I will execute this through my financial advisor and/or attorney by completing the appropriate documents.

It is important to share a copy of this form with your financial advisor and/or attorney as well as the Texas Lyceum to ensure accurate record keeping of your wishes.

The Texas Lyceum is a 501 (c) (3) tax deductible charitable organization. Tax identification number 75-1720024.
My Commitment: I have designated the Texas Lyceum as a beneficiary through my:
Will $ blanks or blank %

Sample Language: "I bequeath the sum of $ _______ or _______ % of my total estate assets to the Texas Lyceum for the purpose of supporting _______."
Life Insurance Policy $ blanks or blank %
Retirement Plan $ blanks or blank %
Contact Information:
Name*

First NameLast Name
Lyceum Class Year
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
I am comfortable with public acknowledgement of this gift. (i.e. donor wall listing)I wish to remain anonymous.
Should be Empty:

Planned Giving Pledge Form