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The Legacy Society — Member Profile

Please fill out the form below to send us your Member Profile, so that we may welcome you into the Legacy Society.

Please note: All highlighted and starred (*) fields are required. Name(s): *
Date of Birth:
Date of Birth (Spouse):
Address: *
City/State/Zip: *
Country:
Telephone:
E-Mail:

Check Below: UT Dallas may include my (and, if applicable, my spouse's) name in the Legacy Society listings. (Neither amount nor designation, if provided, will be included on the listing.)
I am honored to be included in the Legacy Society; however, I prefer to remain anonymous. Please do not include my/our name in the Legacy Society listings.

Please share with us, in confidence, more about your estate provision for The University of Texas at Dallas. The following information is optional.

I have named The University of Texas at Dallas as a beneficiary of my: Will/Trust
IRA or Retirement Plan
Life Insurance Policy
Charitable Remainder Trust
Other (please specify):

This provision is stated as a: Specific dollar amount ($):
Percentage of estate/account (%):

Based on Percentage: If based on a percentage, please estimate the current value of the gift to The University of Texas at Dallas ($):

My gift is: Unrestricted (General Operations)
Designated for:

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