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David Russell Lyman Society — Member Profile

Please fill out the form below to send us your Member Profile, so that we may welcome you into David Russell Lyman Society.

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

Name(s): *

Age:

Age (Spouse):

Address: *

City/State/Zip: *

Country:

Telephone: *

E-Mail: *

Choose Below:

The Hospital may include my (and, if applicable, my spouse's) name in David Russell Lyman Society listings. (Neither amount nor designation, if provided, will be included on the listing.)

I am honored to be included in David Russell Lyman Society; however, I prefer to remain anonymous. Please do not include my/our name in David Russell Lyman Society listings.

Please share with us, in confidence, more about your estate provision for Gaylord Hospital. The following information is optional.

I have named Gaylord Hospital as a beneficiary of my:

Gifts Anyone Can Make

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Charitable Lead Trust

Retained Life Estate

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Retirement Plans

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Life Insurance

Bank Accounts

Jointly Held Accounts

Artwork and Personal Property

This provision is stated as a: Specific dollar amount ($):
Percentage of estate/account (%):

Based on Percentage: If based on a percentage, please estimate the current value of the gift to Gaylord Hospital ($):

My gift is: Unrestricted (General Operations)
Designated for:

Have Questions About Giving?

Our team is here to help. For more information, please call (203) 284-2881 or contact our team via the button below.

Contact Us

Gaylord Specialty Healthcare Development | P.O. Box 400 Wallingford, CT 06492 | (203) 284-2881

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