Confidential Planned Gift Inquiry Form

Salutation:

Mr. Mrs. Ms. Dr.

Name:

Address:

City:

State:

Zip Code:

Telephone:

E-mail:

Please send information on how a Joslin life income gift (e.g. gift annuity or charitable trust) can work for me. For illustration purposes, please model a gift of (minimums: age 60, $10,000):

Cash or Stocks in the amount of:

$5,000 $10,000 $25,000 $50,000
$100,000 or Other amount

My birthdate:
My spouse's birthdate:

(Dates of birth are needed to calculate the income and tax savings you will receive.)

Please send information on how to name Joslin Diabetes Center in my will or retirement plan.

I have already named Joslin Diabetes Center in my will. Please enroll me in The Priscilla White Society.

Please send me more information about The Priscilla White Society.

I am interested in exploring a Joslin life income gift or a bequest to prevent and cure diabetes, because

Any other questions or comments? Please let us know how we may best help you.

When you submit this form, a Development Officer will send information tailored to your circumstances.   If you are interested in how a life income gift or a charitable bequest works, you will receive a letter that explains the gift and financial calculations.  Please note that your personal information is kept strictly confidential.  There is no obligation, just an opportunity for you to learn how you can help Joslin conquer diabetes and receive income and tax savings in return.