Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Work or Mobile Number

(###)

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Planned Gift in Living Will or Trust

I/we have included a bequest to the Southern Oregon Land Conservancy in my/our living will or trust.

Yes

Planned Gift as Beneficiary of Asset

I/we have included the Southern Oregon Land Conservancy as a beneficiary of the following asset:

Charitable Gift Annuity

Life Insurance

IRA or Retirement Plan

Financial Advisor, Attorney, or Other Professional Service Contact

First Name

Last Name

Advisor/Professional Phone

(###)

###

####

Advisor/Professional Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Legacy Circle Listings and Publications

Yes, you may include me/us in planned gift listings and publications.

No, please do not include me/us in listings.