1.Yes, I accept the invitation to join the USCRI Legacy Society. I have provided for USCRI in the following way(s):

Will/Trust

Life Insurance Beneficiary

Retirement Account Beneficiary

Donor-Advised Fund Beneficiary

Pledge for a Future Gift

Other (please specify)

2.My gift is:

A percentage of my estate

A specified amount

I prefer to keep the details confidential.

3.Approximate gift amount (optional):

4.I understand that my commitment to leave USCRI a gift in my estate entitles me to enrollment in the USCRI Legacy Society and special recognition in publications.

Please do not publish my name. I wish to remain anonymous.

Yes, USCRI may publish my name. Please list me/us as:

5.Your Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number