Gift Intention Form

If you have already made a gift to Columbia Memorial Health Foundation, please let us know by completing the form below or contacting us at (518) 828-8362. We would like to thank you and welcome you into our Visionary Society. By letting us know, we can ensure that we fulfill your gift exactly as you intended.

Information you share will be kept confidential and we respect any desire to remain anonymous.

Columbia Memorial Health Foundation: Gift Intention Form
I/we have made a provision to leave a legacy to Columbia Memorial Health Foundation through my/our:

If you selected "Other" or would like to share the value of your gift, please contact Barbara Klassen at (518) 828-8362 or

Please use my gift for the following purpose(s):
Membership listing (please check one):

Please list me / us as follows:

By signing this member profile, I reaffirm my commitment to Columbia Memorial Health Foundation. However, this letter shall not be binding upon my estate, and the information contained herein shall be used for Columbia Memorial Health Foundation purposes only.

Digital Signature

The information you share will be kept strictly confidential. By completing this form, you may receive communication and planned giving email news from Columbia Memorial Health Foundation. You can unsubscribe any time.