Legacy Heart Club Member Information Form

Thank you for your interest in making a planned gift to Sioux Empire United Way. Complete the form below and a represenative from Sioux Empire United Way will contact you with more information.

Your Name

Your Spouse's Name

Address

City

State

Zip

Phone

Gifts

I have included Sioux Empire United Way as a beneficiary in my Will

I have included Sioux Empire United Way as a beneficiary in my Trust

I have named Sioux Empire United Way as a beneficiary on a life insurance policy

I have named Sioux Empire United Way as a beneficiary on a retirement account

Additional/other type of Planned Gift

I/we welcome recognition of this gift in Sioux Empire United Way publications in the following name(s):

I/we prefer to remain anonymous

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