Intention of Legacy Gift

Please provide as much information as you feel comfortable sharing so we can document your generous intentions. Any information shared will remain confidential and does not create a binding obligation to you or your estate.

Name:*

First Name

Last Name

Address:*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number:*

Email:

I/We have included Shriners Hospitals for Children in the following way(s):

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Percentage OR Estimated Value of Gift (Optional)

As directed in my current documentation, I/we designate this gift for the following:

Specific Shriners Hospitals for Children location Area of greatest need

Select Hospital

Locations listed here are for informational purposes only. To ensure that your selected Shriners Hospitals for Children location will receive your intended gift, please make sure to name that location in your will, trust of other legal documents

To recognize our generous donors who have named Shriners Hospitals for Children in their estate plans, we established the Dream Makers Legacy Society. By providing us notification of your intent, we would like to extend an invitation for you to join our Dream Makers Legacy Society.

I/We accept the invitation to become member(s) of the Dream Makers Legacy Society. I/We wish to remain anonymous. As a Dream Makers Legacy Society member, this future gift will be made in honor or memory of:

Name of In Honor or Memory of:

Signature

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Date

Signature

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Date

This document does not bind you or your estate. By signing this form, you are simply acknowledging your current intention to include Shriners Hospitals for Children in your estate plan.

Thank you for your commitment to Shriners Hospitals for Children!
For more information or questions, please contact Bob Hawkes, at 813-367-2794 or bhawkes@shrinenet.org.

If you do not wish to receive any further fundraising communication, or even just a specific type of planned giving communication, from Shriners Hospitals for Children, please contact us by email at plannedgiving@shrinenet.org or call 866-954-1576 to opt out.