Planned Giving Acknowledgement Form
Thank you for your support of the Alisa Ann Ruch Burn Foundation's Planned Giving Program!

Because of you, the Alisa Ann Ruch Burn Foundation is well poised to continue to significantly reduce the number of burn injuries through prevention education, and to enhance the quality of life of those affected by burn injuries in California.

It is important that you provide us with this information so that we may properly honor you and track your contribution!
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Contact Information
Required information is indicated with a red asterisk.
Name(s) First and Last *
Address, City, State, Zip *
Phone Number *
Please indicate the type of phone number: *
E-Mail *
What is your preferred method of communication? *
Please provide information about your gift or intent.
Required information is indicated with a red asterisk.
I/we have included the Alisa Ann Ruch Burn Foundation in my/our will or trust.
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If yes, please indicate the amount or percentage
I/we have established a Charitable Trust for the benefit of the Alisa Ann Ruch Burn Foundation.
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If yes, please indicate the amount
I/we have included the Alisa Ann Ruch Burn Foundation as a beneficiary of my Life Insurance and/or Retirement Plan.
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If yes, please indicate the amount
I/we would like more information about:
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Recognition of Your Gift
We would like to recognize your contribution and commitment to the Alisa Ann Ruch Burn Foundation on our website and marketing materials.
Please indicate if you would like your contribution to be public or remain completely anonymous. *
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