Information submitted through this webform is not legally binding. Personal Information Name: First Name: Last Name: Spouse Name: Spouse First Name: Spouse Last Name: Address: Address: City/Town: State/Province: - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code: Phone: Email: Date of Birth: Your Gift IntentionPlease provide the following information to the best of your ability. I/We want to support the mission of Franklin Park Conservatory through a planned gift as described below: I/We have included a bequest for Franklin Park Conservatory in my/our will or living trust. I/We have named Franklin Park Conservatory as a beneficiary of an asset: Retirement Plan Bank, Investment, or Other Financial Account Life Insurance Policy Other: Enter other… I/We have named Franklin Park Conservatory as a revocable beneficiary of a charitable remainder trust. I/We have named Franklin Park Conservatory as an irrevocable beneficiary of a charitable remainder trust. Approximate anticipated value of gift: Please provide a general description of the gift provision (such as, asset to be donated if other than cash or securities, how gift is to be used, whether gift is to create an endowment, etc.): Indicate your recognition preference below. Please note that the amount of your intended gift will not be published. Your listing may inspire others to leave the Conservatory in their will. Yes, I/We would like to be included in Heirloom Society lists and donor recognition Please indicate how you would like your name(s) to appear in our Heirloom Society listings: No, I/We prefer to be listed as “Anonymous” CAPTCHA Get new captcha! What code is in the image? Enter the characters shown in the image. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank
