Planned Giving Donation Form
Please print this form and mail to the the
regional office of your choice (addresses noted below. )
Call
Sandy Dominick at the Desert Southwest
Chapter
at 602-528-0545 if you have questions regarding this form.
All information provided is
confidential.
-
Central Arizona Region, 1028 E.
McDowell Road, Phoenix, AZ 85006
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Southern Arizona Region, 3003 S.
Country Club Rd., Ste. 209, Tucson, AZ 85713
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Northern Arizona Region, 225 Grove
Ave., Ste. B, Prescott, AZ 86301
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Southern Nevada Region, 5190 S.
Valley View Blvd., Ste. 101, Las Vegas, NV 89118
A bequest to the Alzheimer’s Association Desert Southwest
Chapter is a living testimony to your endorsement of our vision of a world
without Alzheimer’s disease. You help us fulfill our mission. If you have included us in your
will, or are planning to do so, we thank you.
Completing this information is personal and confidential.Name:
____________________________________________________
Address: __________________________________________________
Telephone ( )____________________E-mail______________________
City: _________________________ State:____________ Zip:_______
Type of gift: Will _____ Trust_____Gift Annuity_____
Personal Property____ Life Insurance ____ Other ____
Estimated Value of my Bequest $_____________
I need more information about ____________________________________________________
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