Join the 1987 Legacy Society

This form is to advise Postpartum Support International (PSI) of your philanthropic intent to make a planned or deferred gift to PSI. The information collected on this form is not a binding commitment and you retain the right to change or revoke your gift at any time with or without notice to PSI.

PSI’s 1987 Legacy Society recognizes individuals and couples who have notified us that they have included PSI in their Will or other deferred giving plan. To join the 1987 Legacy Society, we will need this simple notice documenting your future gift.

OPTIONS: (please check boxes that apply) *

I/We have made a provision for Postpartum Support International in my/our estate plans and wish to be included in the Legacy Society.
I/We have made a provision for a gift, but prefer not to be listed as members of the Legacy Society.
I/We have not yet planned for a future gift, but would like more information about how to leave a legacy through our Will or other planned giving arrangement.

First Name *

Last Name *

Birth Date *

// (mm/dd/yyyy)

Spouse's First Name

Spouse's Last Name

Spouse's Birth Date

Please list my/our name as: *

Address 1 *

Address 2

City *

State/Province *

Zip *

Country *

Phone

Email *

PSI’s Federal Tax ID Number: 77-0196208

We appreciate additional information on your gift if you are willing to disclose it:

I have included Postpartum Support International in my: (please check boxes)

Will
Retirement Plan
Donor Advised Fund
Revocable Living Trust
Life Insurance Policy
Other

For the amount of:

I have funded a(n):

Charitable Gift Annuity
Charitable Remainder Trust
Charitable Lead Trust
Endowment
Pooled Income Fund
Retained Life Estate
Other Asset

Signature [Type full name here.] *

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Join the 1987 Legacy Society