Name *

First Name

Last Name

I prefer to be contacted: *

by email

by mail

by phone

through my attorney (provide contact information at the bottom of this form)

Regular Mail *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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Beth Israel Center is or will be named as a beneficiary in my/our estate plan. *

Yes

Not yet - I have questions. Please contact me.

Privacy Statement *

I/we understand that listing my/our name(s) may encourage others to make similar commitments, so my/our name(s) may be listed wherever Legacy Gifts to Beth Israel Center are acknowledged.

I/we prefer to remain anonymous and receive no public recognition of our planned gift.

My/our estate plan includes gift(s) to Beth Israel Center in the form of:

Bequest in my/our will(s)

Distribution from my/our trust(s)

Designation from my/our retirement plan(s)

Recommendations from a donor advised fund

Gift of life insurance

Other (specify below)