Name(s)
Address
City
State
Zip
Phone
Email
Birthdate
Spouse Birthdate
Signature
YES! I/We confirm that I/we have made a planned gift to Friends/Iowa Public Television
Foundation. By making this gift, we are encouraging others to follow our leadership example. Please check one of the following:

I/we give my/our permission to the Friends/IPTV Foundation to publicly recognize my/our membership in the Friends Legacy Society in printed materials. (Please use my/our name as it is listed to the left.)

I/We prefer to remain anonymous. Please do not list my/our name in your publication.
My/Our planned gift is in the form of a:
_____ Will Bequest
_____ Trust
_____ Annuity
_____
_____
Retirement Plan
Other
Optional
Estimated value of gift: $ ____________________________________________
Benefits of the IPTV Friends Legacy Society

Lifetime subscription to Advance

Invitations to special events

VIP Tour of IPTV (upon request)
 Borrowing privileges with IPTV’s

Recognition of your gift (unless anonymity is preferred)

The satisfaction of knowing you have made a significant contribution video lending library

Visions Newsletter to the future of IPTV.
“This is not just planned giving. This is immortal philanthropy.”
Please return form to IPTV Foundation, PO Box 6400, Johnston, IA 50131-6400
OR call 800-728-2828 and ask for the Major and Planned Gifts Department.