Legacy Society Membership Form

Thank you for your generous commitment to support Minnesota Public Radio through a Planned Gift. Your dedication ensures the sustainability of our programming for years to come. To assist us in honoring your legacy, please complete this form.

Contact Information

First Name

Last Name

Address

City

State

Zip or Postal Code

Email Address

Preferred Phone Number

Do not clear placeholder values; simply type phone number directly.

Preferred Phone Type

Date of Birth

Please enter in MM/DD/YYYY format.

Spouse / Partner First Name (If Applicable)

Spouse / Partner Last Name (If Applicable)

Spouse / Partner Date of Birth (If Applicable)

Gift Details

Type of Planned Gift (Select all that apply)

WillRevocable trustRetirement accountLife insurance policyCharitable remainder trustOther

Minnesota Public Radio will receive:

A specific dollar amountPercentage of estate

Percent of estate:

Please provide the approximate value of your gift if it were to be realized today:

Designation:

Minnesota Public Radio - UnrestrictedAmerican Public Media - UnrestrictedMarketplace - UnrestrictedOther Program (please specify)

Please specify

Legacy Society Recognition

Feel free to publish my/our name(s) among your lists of Legacy Society members.Do not publish my/our name(s) on the Legacy Society roster. I/we prefer to be listed as "Anonymous"

I/we wish my/our name(s) to appear as (for example, Jane D. and John Q. Doe):

MPR Legacy Society listings will never reference your gift amount. We understand that this amount can change over time or may be revoked.

Please share the story of how Minnesota Public Radio became a part of your life:

Contact Information

Thank you. We are grateful for your support!