Phillips Society Membership Form

The Phillips Society recognizes and celebrates friends who create a lasting legacy of giving that advances medicine and scientific discovery by including Massachusetts General Hospital in their estate plans.

The information you provide here about your legacy gift for Mass General is confidential but will ensure that our records are accurate and that we use your gift in the way you intend. We understand that the value of future gifts and the provisions themselves may change over time. Completing the Phillips Society membership form carries no obligation on your part. If you decide to change your plans in the future, simply notify the Office of Planned Giving.

1. Full Name/Names *This question is required.

2. Email *This question is required. This question requires a valid email address.

3. Phone Number *This question is required. This question requires a valid number format.

4. Address

Street Address *This question is required.

City *This question is required.

State/Province/Region *This question is required.

Zip/Postal Code *This question is required.

Country *This question is required.

5. My/our future gift is from: *This question is required.

Will/Trust
IRA/Retirement Account
Bank, Brokerage or Donor-Advised Fund
Life Insurance Policy
Charitable Remainder Trust
Charitable Gift Annuity or Pooled Income Fund
Other Gift Plan (please specify): Please enter an 'other' value for this selection.

6. The estimated value of my/our future gift is:

The specific amount or percentage of my estate estimated to be worth:

7. My/our future gift will support: *This question is required.

Unrestricted (MGH Fund)
Other (please specify): Please enter an 'other' value for this selection. * This question is required.

8. Check one if applicable:

Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.

9. Allowing us to acknowledge your support publicly is like giving twice. Your gift supports the future work of Mass General, and your name provides an example for others to follow. Since you've remembered Mass General in your estate plan, please select one option below * *This question is required.

Please enter an 'other' value for this selection.

10. Comments