Name(s): *
School/Class: *
Address: *
City/State/Zip: *
Telephone:
E-Mail:

Please check one:
	William & Mary may include my (and, if applicable, my spouse's) name in The Honorable Robert Boyle Legacy Society listings. (Neither amount nor designation, if provided, will be included on the listing.) Please list me / us as follows:
	I am honored to be included in the Boyle Legacy Society, however I prefer to remain anonymous. Please do not include my/our name in the Boyle Legacy Society listings.

The following information is optional:

Please tell us more about your estate provision for William & Mary.

I have named William & Mary as a beneficiary of my:

	Will/trust for: a specified amount a specified percentage		Life Insurance Policy
			Charitable trust as remainderman
	IRA or retirement plan
	Other (please specify):

My gift is:

Unrestricted

Designated for:

Estimated current value

as of (date)