English - International Waldenstrom's Macroglobulinemia Foundation
English - International Waldenstrom's Macroglobulinemia Foundation
English - International Waldenstrom's Macroglobulinemia Foundation
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
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