Information submitted through this webform is not legally binding. Personal Information Name: First Name: Last Name: Spouse Name: Spouse First Name: Spouse Last Name: Address: Address: City/Town: State/Province: - None - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming ZIP/Postal Code: Phone: Email: Date of Birth: Spouse Date of Birth: Your Gift IntentionTo notify Allentown Art Museum that an estate gift has been arranged for its benefit, please fill out the below form or print and mail this form and additional documentation to: 31 North Fifth Street, Allentown, PA 18101. I/We want to support the mission of Allentown Art Museum through a planned gift as described below: I/We have included a bequest for Allentown Art Museum in my/our will or living trust. I/We have named Allentown Art Museum as a beneficiary of an asset: Retirement Plan Bank, Investment, or Other Financial Account Life Insurance Policy Other: Enter other… I/We have named Allentown Art Museum as a revocable beneficiary of a charitable remainder trust. I/We have named Allentown Art Museum as an irrevocable beneficiary of a charitable remainder trust. Approximate anticipated value of gift: Please provide a general description of the gift provision (such as, asset to be donated if other than cash or securities, how gift is to be used, whether gift is to create an endowment, etc.): Yes, you may include me/us in listings of planned gift donors. Please indicate how you would like your name(s) to appear in our 1934 Legacy Circle listings. (Please note the amount of your intended gift will not be published): No, please do not include me/us in listings. CAPTCHA Get new captcha! What code is in the image? Enter the characters shown in the image. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank
