Vision Society Enrollment Form Vision Society Vision Society Planned Giving Enrollment Form "*" indicates required fields Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Birth MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberBirth Day12345678910111213141516171819202122232425262728293031I would like to remain anonymous* No Yes I have included Fidelco Guide Dog Foundation in my estate plan. My gift is in the form of:* Bequest IRA Charitable Rollover Life Insurance Gift Retirement Plan Assets Charitable Lead Trust Charitable Remainder Trust (CRT) Gift Annuity Other For other, please describe:Amount of gift
