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The Heritage Circle — Member Profile

Please fill out the form below to send us your Member Profile, so that we may welcome you into the Heritage Circle.

Please note: All highlighted and starred (*) fields are required.

Please choose one:
	UCSF may include my (and, if applicable, my spouse's) name in the Heritage Circle listings. (Neither amount nor designation, if provided, will be included on the listing.)
	I am honored to be included in the Heritage Circle; however, I prefer to remain anonymous. Please do not include my/our name in the Heritage Circle listings.

I have named the UCSF Foundation as a beneficiary of my:

This provision is stated as a:

	Specific dollar amount ($):
	Percentage of estate/account (%):

If based on a percentage, please estimate the current
value of the gift to the UCSF Foundation ($):

My gift is:

	Unrestricted (General Operations)
	Designated for:

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Jackie and Carl Kuhn have connections to UC that go back many years.

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