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:
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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.
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My/Our planned gift is in the form of a:
_____ Will Bequest
_____
_____
Trust
Annuity
_____
_____
Retirement Plan
Other
Optional
Estimated value of gift: $ ____________________________________________
Lifetime subscription to
Advance
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Recognition of your gift (unless
Invitations to special events anonymity is preferred)
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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.