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Mary Lyon Society Membership Form

Thank you for making Mount Holyoke College a part of your legacy. It is easy to become a member of the Mary Lyon Society. Simply complete the information below to inform the College of your intentions.

We look forward to welcoming you into the Mary Lyon Society.

Please note: All highlighted and starred (*) fields are required.

Name(s): *

Class Year (if applicable):

Spouse Name (if applicable):

Address:

City, State, Zip:

Telephone:

Email: *

OPTIONAL DETAILS
Please complete the following if you would like to share additional details about your gift with the Office of Gift Planning:

I have named Mount Holyoke in my estate plan via:

Will/Living Trust

IRA or Retirement Plan

Life Insurance Policy

Charitable Remainder Trust

Beneficiary of Donor Advised Fund

(please specify):

Percentage of estate/account:

Specific dollar amount:

Please choose one:

Please include my name (and, if applicable, my spouse’s name) in the Mary Lyon Society

I am pleased to be included in Mary Lyon Society; however, I prefer to remain anonymous

My gift is:

Unrestricted

Intended for the following purpose:

Please add a purpose:

I would like you to contact me at:

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Mary Lyon Society Membership Form

A Member of the