Phillips Society Membership - Massachusetts General Hospital Giving

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Phillips Society Membership Form

Full Name/Names (Required)

Email (Required)

Phone (Required)

Address (Required)

Street Address

Address Line 2

City

ZIP / Postal Code

Country

My/our future gift is from: (Required)

Will/Trust

IRA/Retirement Account

Bank, Brokerage or Donor-Advised Fund

Life Insurance Policy

Charitable Remainder Trust

Charitable Gift Annuity or Pooled Income Fund

Other Gift Plan (please specify):

The estimated value of my/our future gift is:

The specific amount or percentage of my estate estimated to be worth:

My/our future gift will support: (Required)

Unrestricted (MGH Fund)

Other (please specify):

Check one if applicable:

I am making this gift in honor or memory of somebody

Allowing us to acknowledge your support publicly is like giving twice. Your gift supports the future work of Mass General, and your name provides an example for others to follow. Since you've remembered Mass General in your estate plan, please select one option below * (Required)

I/We would like to be recognized by name as a Phillips Society member(s) in publications such as in the online donor reports and Phillips Society Luncheon Program Book. I/We prefer to remain anonymous in any Phillips Society publications. Preferred Phillips Society Listing

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