Legacy Donor Circle Enrollment Form

The Legacy Donor Circle celebrates and recognizes the generosity of forward thinking individuals who make the important choice to support the mission of Mount Madonna through their estate plans. Membership in the Legacy Donor Circle is extended to individuals who have shared that they have made future provisions for Mount Madonna through their will or living trust, designation as a beneficiary of a retirement plan or life insurance policy, or by making a life income gift.

Questions about this form? Please contact our Philanthropy Director:
Andy Tompsett
(408) 837-8091
Andy@MountMadonna.org

Donor Information

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Preferred Method of Communication:

Mail

Phone

Gift Statement

I / we have made a provision for Mount Madonna in my / our estate plan in the following
way(s) [please select all the apply]:

Bequest

Retirement Plan Assets (IRS, 402(k), 403(b), etc.)

Life Insurance Desigation

Donor Advised Fund Beneficiary

Charitable Gift Annuity or Charitable Trust

Property

Bequest:

Percentage

Residual

Specific

Percentage

Please enter a number from 0 to 100.

Please use this gift to support:

Mount Madonna’s greatest need

Specific purpose

Philanthropic Focus Areas:

→ Learn more about our four Mission-aligned focus areas here.

Mount Madonna will receive this gift:

Upon my passing

Upon the passing of my surviving spouse

Other

(Optional) Estimated current amount of gift:

DONOR RECOGNITION

You may recognize me / us as Legacy Donor Circle member(s) in Mount Madonna publications. The estimated amount of your gift will never be disclosed publicly. My / our name should appear as:

Anonymous donation

I / we prefer to remain anonymous.

FUTURE CONTACT

Please provide the following information for the individual / organization (e.g. personal representative, executor, attorney, advisor) we can contact in the future about your gift:

Name

First Last

Phone

Relationship

CONFIRMATION

By signing this Legacy Donor Circle Enrollment Form, we reaffirm our commitment to Advaita Society/Hanuman Fellowship dba Mount Madonna Center.

However, this letter shall not be binding upon our estate, and the information contained herein shall be used for Advaita Society/Hanuman Fellowship dba Mount Madonna Center purposes only.

Donor 1

First Last

Date of Birth

Month

Day

Year

Donor 2

First Last

Date of Birth

Month

Day

Year

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Gratitude

Thank you for supporting our mission

Mount Madonna Center and Institute operate under the auspices of the Advaita Society – Hanuman Fellowship, a 501c3 non-profit educational organization. All donations are tax deductible to the extent allowed by law.