Charitable Gift Annuity Enrollment Request Form

Please fill out the form below to request an enrollment packet. This information is sent to the Office of Legacy Gifts via our secure server.

If your browser is not showing this page as a secure site, please switch to our secure server before completing this form.

For more information contact giftplans @ uua.org.

Last updated on Tuesday, January 6, 2009.

Unitarian Universalist Association of Congregations | 25 Beacon Street | Boston, MA 02108 | (617) 742-2100 | info @ uua.org

All Information is Confidential
Name:
Street Address:
City/Town:
State/Province:
Zip/Postal Code:
Congregation:
Email:
Telephone (day):
Telephone (evenings):
Best Time to Call:
Person to Receive the Annuity:
Birthdate:
Second Annuitant (if applicable):
Birthdate (if applicable):
Amount of Gift ($5,000 minimum):
Our/My Gift Will Be:	Cash Stock Other (please specify):