Glens Falls Hospital

100 Park Street, Glens Falls, NY 12801 518.926.1000

ON-LINE Membership Enrollment for The 1897 Circle

If you wish to become a member of The 1897 Circle, simply complete the form below and submit it to the Glens Falls Hospital Foundation Office. When requested, anonymity is respected and we appreciate all donors and gift intents. However, to help in future planning, information on the size and type of the eventual gift is very much appreciated.

Please contact the Foundation Office if you have questions or comments at (518) 926-5960.

All inquires are confidential.

 

Please provide the following contact information:

Full Name
Spouse's Name
  (if joint membership is desired)
 
Address
City
State/Province
Zip/Postal code
Phone
E-mail

I/We have provided for Glens Falls Hospital in my estate plan in the following way(s):
(Please mark all that apply)

I/We named the Foundation as a beneficiary of
my/our charitable remainder trust or charitable gift annuity.
I/We named the Foundation as a beneficiary of
my/our life insurance policy.
I/we have named the Foundation as a beneficiary of
my/our will or trust.
I/we have named the Foundation as a beneficiary of
my/our retirement plan.

Note: Field with bold titles are required