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American Liver Foundation
39 Broadway, Suite 2700
New York, New York 10006

212-668-1000 Tel
212-483-8179 Fax

Home > About Us > The Legacy Society > Member Profile

Legacy Society Member Profile

Please fill in the fields below and click submit. Your profile information will not be shared with anyone and will be held in the strictest confidence.

* Required Fields
Full Name(s)*
Date of Birth
Date of Birth (spouse)
Street Address*
Zip Code*
Email Address*
Please designate whether you approve or not of displaying your name(s) in the Legacy Society listings*
Yes, include my (and, if applicable, my spouse's) name in the listings (amounts or designations not included) No, I/we prefer to remain anonymous – do not include my/our name in the listings
I have named the American Liver Foundation as a beneficiary of my (select all that apply):
Will / TrustIRA or Retirement Plan
Life Insurance PolicyCharitable Trust
Donor Advised FundOther
If other, please specify
Estate provision stated as:

Specific dollar amount ($)

Percentage of estate / account (%)

If based on a percentage, please estimate the current value of the gift to the American Liver Foundation
I approve of my gift being used for general operations (unrestricted use)
Or… I designate my gift to be used specifically for:

Page updated: June 17th, 2015


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