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2. Thank you for remembering the Museum in your plans!
   Please complete the form below to help us account for your future gift or gifts.
4. I am planning a gift through one of the following methods:

   1. I have included the Museum in my will through a Bequest
   2. I have set up a life income gift like a Charitable Remainder Trust or Gift Annuity
   3. I have named the Museum as a beneficiary to my IRA/Retirement Plan
   4. I have named the Museum as beneficiary to a Life Insurance Policy
   5. I would like more information about these and other ways to give
6. The value of my gift is in the range of:

   1. $1,000 - $10,000
   2. $10,001 - $25,000
   3. $25,001 - $50,000
   4. $50,001 - $100,000
   5. $100,001 - $250,000

   1. $250,001 - $500,000
   2. $500,001 - $1,000,000
   3. Over $1,000,000
   4. I don't know or would rather not say
8. I plan to give personal property including:

   1. Real Estate
   2. Works of Art
   3. Other Personal Property
10. Would you like to join the Museum's Legacy Society?

    1. Yes
    2. No

    Legacy Society members receive special recognition on donor panels at the Museum, are recognized in Museum publications, and are invited to special events and programs.
12. My/Our name(s) should appear as follows:
14. I do not wish to receive any public recognition for this gift:

    1. I would like this gift to remain anonymous
16. Title
    -- Select One --Ms.Mr.Mrs.Dr.
17. First Name
18. Last Name
20. Title
    -- Select One --Ms.Mr.Mrs.Dr.
21. First Name (Spouse)
22. Last Name (Spouse)
24. Address1
26. Address2
28. City
29. State
30. Zip
32. Home Phone
33. Other Phone
35. Email Address
37. Thank you for your support!
    If you have any questions or need more information, please contact Nick Nelson, Museum Director, at (417) 837-5700 nnelson@springfieldmo.gov
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

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