Clark University | Alumni & Friends

Alumni & Friends
950 Main Street • Worcester, MA 01610
Tel: 508 793 7166 •

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Clark University - Legacy Society Form

JOIN THE LEGACY SOCIETY

Alumni and friends who have included Clark University in their estate plans through a will, trust, retirement plan, life insurance or life income gift are eligible to join the Legacy Society. The University recognizes and honors it's members annually at a special Legacy Society Luncheon .

Confidential Reply Form

	I have included Clark University in my will and wish to be recognized as a member of the Legacy Society.
	I have made a life-income gift naming Clark University as beneficiary and wish to become a member of the Legacy Society.
	I have made other estate provisions for Clark University and wish to become a member of the Legacy Society. Please Describe:

I wish my name to appear in the Legacy Society Roster
I wish to be an anonymous member of the Legacy Society

Personal Information
Your name and other identifying information will not be sold or shared with any person or organization. Your e-mail address or telephone number may be used by authorized Clark University employees to contact you concerning your comments or questions.

*Required Fields

Mr. Mrs. Ms. Dr. (Select One)
*Clark Affiliation
Class Year
*First Name
Middle Initial
*Last Name
*Address
Apt.#
*City
*State	(select n/a if outside US)
*Zip Code
Country	(for international address)
Phone
E-mail
Date of Birth	Month Day Year
Spouse

PLEASE CLICK ON THE BUTTON BELOW TO SUBMIT
YOUR REQUEST

Thank you!