Riley Children's Foundation

Gift Planning

Horizon Society Enrollment Form

Thank you for supporting Indiana�s children. Please tell us about yourself.

* Indicates a required field

Name(s): *
Date of Birth:		Date of Birth:
Address: *
City/State/Zip: *
Telephone:
E-Mail:

Please check one:

You may include my (and, if applicable, my spouse�s) name in Riley Horizon Society honor roll listings. (Amounts and designations, if provided, are not listed on honor rolls.)

Please list me / us as follows:

I am honored to become a Horizon Society member, however I prefer to remain anonymous. Please do not include my/our name in Riley Horizon Society honor roll listings.

The following information is optional:

Please tell us more about your gift plans for Riley Children's Foundation.

I have named Riley Children's Foundation as a beneficiary of my:

Will/trust for:

	a specified amount
	a specified percentage

Life Insurance Policy

Charitable trust as remainderman

IRA or retirement plan

Other (please specify):

My gift is:

Unrestricted

Designated for:

Estimated current value

as of (date)