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English - International Waldenstrom's Macroglobulinemia Foundation

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THE BEN RUDE HERITAGE SOCIETY ENROLLMENT<br />

by Dick Weil a n d, Vice President for Fundraising<br />

Significant resources have been generated for IWMF through the Ben Rude Heritage Society by legacy gifts. More and more<br />

members and friends are asking about the Society so we thought we would reproduce the enrollment form here and cordially<br />

invite you to become a member of the Ben Rude Heritage Society. We are confident your legacy will prove to be an inspiration<br />

to others. We hope also that you will consider providing information about your legacy by completing the form below so we have<br />

a full understanding of your wishes. Use the enclosed envelope to facilitate your response. If possible, please attach supporting<br />

documentation. Thank you.<br />

LEGACY GIFT<br />

I/We have arranged a legacy gift for the benefit of IWMF through my/our:<br />

❑ Will ❑ IRA/Retirement-Plan Beneficiary Designation ❑ Trust ❑ Charitable Remainder Trust<br />

❑ Other (please specify): _____________________________________________________________________________________<br />

Additional Information:_ ____________________________________________________________________________________<br />

DESIGNATION<br />

This gift is to be used for the following purpose: (please check one)<br />

❑ IWMF’s Greatest Need ❑ Research Fund ❑ Dr. Kyle Endowment Fund ❑ Fellowship Stipend Fund<br />

❑ Other Named or Designated Fund:___________________________________________________________________________<br />

GIFT DETAILS<br />

As of this date, the value of my/our gift is: the sum of $___________________ or _______% of my/our estate or other gift plan,<br />

with the current value of the IWMF portion estimated at $___________________. I/we understand that my/our estate is not legally<br />

bound by this statement of gift value.<br />

RECEIPT OF GIFT<br />

This gift will be received by IWMF after the life of:<br />

❑ The First Donor ❑ The Surviving Donor/Spouse ❑ Other Individual(s):_ ___________________________________<br />

❑ Other Contingencies or Stipulations such as:_ _________________________________________________________________<br />

BEN RUDE HERITAGE SOCIETY HONOR ROLL LISTING:<br />

Name(s):_________________________________________________________________________________________________<br />

❑ Please enroll me/us in the Ben Rude Heritage Society using the Honor Roll listing above.<br />

❑ Please do not list my/our name(s) in the Honor Roll and _____in all other publications.<br />

❑ Typically, IWMF recognizes Heritage Society membership with a recognition piece.<br />

Check here if you prefer not to receive this token of appreciation.<br />

Donor Signature:___________________________________ Date of Birth:_ ________________ Date:_ ____________________<br />

Donor Signature:___________________________________ Date of Birth:_ ________________ Date:_ ____________________<br />

Please note that all information will remain confidential to IWMF. For further information about the Ben Rude Heritage Society, please contact<br />

Dick Weiland at rjweiland@msn.com or 507.645.2633<br />

IWMF TORCH Volume 11.2<br />

15

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