The Lofty Elm Society — Member Profile

Please fill out the form below to send us your member profile to be welcomed into the Lofty Elm Society.

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

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

Please check one:
	SUNY Cortland through the Cortland College Foundation may include my (and, if applicable, my spouse's) name in the Lofty Elm Society listings. (Neither amount nor designation, if provided, will be included on the listing.) Please list me/us as follows:
	I am honored to be included in the Lofty Elm Society; however I prefer to remain anonymous. Please do not include my/our name in the Lofty Elm Society listings.

Please tell us, in confidence, more about your estate provision for Cortland College Foundation, Inc.

I have named the Cortland College 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 (General Operations)
	Designated for:

Estimated current value (optional)

as of (date)