William Penn Charter School

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Would you like me to give you a call?

John T. Rogers
Senior Gift Officer
Name

Phone Number

Membership Form

Welcome to The Pinehurst Society! Please fill out and submit this membership form. We will be in touch with you within five business days to confirm your membership. The information you provide on this form will be held in the strictest confidence by the Office of Planned Giving, subject to the authorizations you provide below.

* Indicates a required field

I/we have included Penn Charter in my/our Will or revocable trust

A specific bequest.

Amount or value

$


A percentage bequest of

%.

Estimated value $


Other (describe):

Please list any specified purpose or restrictions.

I/we have named Penn Charter in an irrevocable trust or life-income arrangement

Charitable Remainder Unitrust or Annuity Trust

Foundation interest

%.

Current market value of trust $


Testamentary Charitable Lead Trust

Foundation interest

%.

Expected payout $

Term of years


Other (describe)

I/we have made Penn Charter the beneficiary of

A life insurance policy

Death benefit $

Current cash surrender value $

The School is

Primary beneficiary

Secondary beneficiary

(check one only)

A Qualified Retirement Plan (IRA, 401k, 403b)

Foundation interest

%

Current market value of plan $

The School is

Primary beneficiary

Secondary beneficiary

(check one only)

Documentation

Yes, I/we will share a copy of the portion of the Will that applies to Penn Charter or the trust agreement or Change of Beneficiary Form (401k, 403b, IRAs, Insurance) in which the School is named.


Authorization for Use of Name

I/we authorize Penn Charter to include my/our name(s) on the membership list of The Pinehurst Society in School publications and on public recognition devices. I/we understand that this authorization is limited to the use of my/our name(s) only, and that the type and amount of my/our gift to the School will remain strictly confidential.


I/we prefer my/our membership to remain anonymous.

Security Key*

Please note: Submission of this form signifies your consent to the information provided and authorizations selected.

How to Contact Us:

Office of Development
William Penn Charter School
3000 West School House Lane
Philadelphia, Pennsylvania 19144
Phone: 215-844-3460 x111
Email: jarogers@penncharter.com