Legacy Society Enrollment Form

Required

PERSONAL INFORMATION
NamerequiredAs you wish it to appear on donor lists.
First Name
Maiden (optional)
Last Name
As you wish it to appear on donor lists.
Must contain only numbers
Preferred method of contact:requiredCheck all that apply.
Check all that apply.
LEGACY SOCIETY ENROLLMENT INFORMATION
As a supporter of the mission of the Academy of the Holy Names, I accept membership in the Holy Names Legacy Society. I understand that I will remain a member of the Legacy Society as long my gift plan remains in place. I will notify the Academy of the Holy Names if I change my plans. I understand that my gift is unrestricted unless I specifically indicate otherwise. 
I have arranged a gift by naming the Academy of the Holy Names of Florida, Inc.( Federal tax ID number 59-0910354):
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For more information, please contact the AHN Office of Advancement at 813.839.5371 ext. 376.