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1787 Society Member Profile

Please fill out the form below to send us your member profile to be included into 1787 Society.

* Indicates a required field

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

Please check one:
The University of Pittsburgh may include my (and, if applicable, my spouse’s) name in 1787 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 1787 Society, however I prefer to remain anonymous. Please do not include my/our name in 1787 Society listings.

The following information is optional:

Please tell us more about your estate provision for the University of Pittsburgh.

I have named the University of Pittsburgh 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)