Please let us know if you have made a planned gift as this allows us to plan for the future. More importantly, we would welcome the opportunity to honour and thank you in person and invite you to our events, where we can share the latest medical achievements at London Health Sciences Centre (LHSC), show you the positive impact that planned gifts are having and the legacy your generosity and forethought is leaving for future generations.

		I have already included London Health Sciences Foundation (LHSF) in my Will.
		I intend to include LHSF in my Will.
Details of your plans would be helpful in LHSF's planning for the future if your wish to share them.
My bequest will be:
		A percentage of the estate.	%
		A specific amount.	$
		The residue of my estate after the bequests are made.
		A specific item of value. Details:
Please indicate which area of work you want to benefit with your bequest gift:
		Overall work of LHSC providing the most flexible gift for the future needs of healthcare
		Research
		Patient Care
		Equipment
		Education
		Other
London Health Sciences Foundation would like to thank you for the intended bequest gift in your will.
		I authorize LHSF to list my name as one of the "Donors for Tomorrow" who have taken a significant step to ensure superior healthcare in the future.
		I wish to make my bequest confirmation anonymously.

Information About You
Full Name (Mr./Mrs./Ms./Dr.)	Date of Birth (mm/dd/yy)
Address (Number and Street)	City
Province	Postal Code
Phone	Email
Spouse's Name (Mr./Mrs./Ms./Dr.) (If applicable)	Spouse's Date of Birth (mm/dd/yy) (If applicable)