The AOPA Foundation, Inc.

The AOPA Legacy Society Membership Form

Please fill and submit this form online or print it out and mail it to

The AOPA Legacy Society
The AOPA Foundation, Inc.
421 Aviation Way
Frederick, MD 21701

I am honored to be among the initial Charter Members of The AOPA Legacy Society. I understand that membership is conferred to those who have established and documented a planned gift to benefit The AOPA Foundation, Inc. or The AOPA Air Safety Foundation.

I wish The AOPA Foundation, Inc. to know that I have (check all those that apply):

	listed The AOPA Foundation, Inc. or the AOPA Air Safety Foundation as a beneficiary in my will or living trust
	established a charitable gift annuity to benefit The AOPA Foundation, Inc.
	named The AOPA Foundation, Inc. or The AOPA Air Safety Foundation as a beneficiary of my qualified retirement plan (IRA, 401(k), 403(b), SEP, or other such plan)
	named The AOPA Foundation, Inc. or The AOPA Air Safety Foundation as the owner and/or beneficiary of a life insurance policy
	listed The AOPA Foundation, Inc. or The AOPA Air Safety Foundation as a beneficiary of a charitable trust

	To help encourage others to participate, The AOPA Foundation may recognize me in writing in AOPA-related publications such as The Philanthropy Report. Please list my name as:
	I prefer to remain anonymous.

*	Name:
	AOPA Member Number :
	Address:
	City:
	State/Province:
	Postal Code:
	Country:
*	E-mail:

	Phone (daytime):
	Phone (evening):
Questions or Comments: All fields marked with the asterisk symbol () are required. This information is kept confidential. The form notifies The AOPA Foundation of your intention and your donor listing preference. This form does not create an obligation. If at any time you decide to change your plans, please let The AOPA Foundation know, and we will remove your name from The AOPA Legacy Society membership list.

Updated June 16, 2008