Founding Member Enrollment Form

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Friends Legacy Society

Member Information

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

Recognition of your gift (unless

Invitations to special events anonymity is preferred)

VIP Tour of IPTV (upon request)

Borrowing privileges with IPTV’s video lending library

The satisfaction of knowing you have made a significant contribution to the future of IPTV.

Visions

Newsletter

“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.

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