Celebration Circle Form

Please complete the following form as you Confidential Statement of Intent to join the To Celebrate Life Celebration Circle

Name*
First Last
Email*
Address*
Street Address City State ZIP Code
Your Message*
I/we have made the following provision for a planned gift to the To Celebrate Life Breast Cancer Foundation:*
- Bequest
- Charitable Remainder Trust
- Life Insurance
- Charitable Lead Trust
- Retirement Plan Designation
- Other
In recognizing the gift, To Celebrate Life Breast Cancer Foundation is authorized to list the following name(s) as members of the To Celebrate Life Celebration Circle:*
- I/we have made provision for a gift but prefer confidentiality and wish to be an anonymous member of the To Celebrate Life Celebration Circle.
- It is my/our intention that this gift be an endowed (permanent) gift to To Celebrate Life Breast Cancer Foundation.
- I/we wish to consider a planned gift and would like to be contacted to discuss my gift.

Your contributions support women and men in our
community through all phases of their breast cancer
journey from diagnosis to treatment and healing.