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Gift Planning

Heritage Society Membership Form

Yes, I would like to be included in the Diabetes Research Institute Heritage Society. The legacy I have created to help find a cure for diabetes has been established by using the following gift planning vehicle(s):

Bequest in Will or Living Trust
Charitable Gift Annuity
Charitable Remainder Trust
Charitable Lead Trust
Life Insurance
IRA or other Retirement Plan

Contact Information

*First Name:
Middle Initial:
*Last Name:
Address:
Address:
City:
State/Province/Region:
ZIP/Postal Code:
Country:
*E-mail Address:
Contact Phone Number:
Birth date:

This declaration is not a legal obligation and may be changed at my discretion.

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