Support Gifford Our Legacy Society — Member Profile Please fill out the form below to send us your Member Profile, so that we may welcome you into Our Legacy Society. Please note: All highlighted and starred (*) fields are required. Name(s): * Age: Age (Spouse): Address: * City/State/Zip: * Country: Telephone: * E-Mail: * Choose Below: Gifford may include my (and, if applicable, my spouse's) name in Our Legacy Society listings. (Neither amount nor designation, if provided, will be included on the listing.) I am honored to be included in Our Legacy Society; however, I prefer to remain anonymous. Please do not include my/our name in Our Legacy Society listings. Please share with us, in confidence, more about your estate provision for Gifford Medical Center. The following information is optional. I have named Gifford Medical Center as a beneficiary of my: Gifts Anyone Can Make Will or Trusts Appreciated Securities Life Insurance Retirement Plans Gifts That Pay You Income Charitable Gift Annuity Deferred Gift Annuity Pooled Income Fund Charitable Remainder Unitrusts Charitable Remainder Annuity Trusts Gifts That Protect Your Assets Bargain Sale Charitable Lead Trust Retained Life Estate This provision is stated as a: Specific dollar amount ($): Percentage of estate/account (%): Based on Percentage: If based on a percentage, please estimate the current value of the gift to Gifford Medical Center ($): My gift is: Unrestricted (General Operations) Designated for:
