Legacy Planning: Declaration of Future Intent

Thank you for your intention to include The Michael J. Fox Foundation For Parkinson’s Research in your estate plan. In order to accurately document your intention, please complete this form with as much detail as you are willing to share. Any information about your gift will remain confidential and does not create a binding obligation.

Questions? Contact us at plannedgiving@michaeljfox.org or 212-509-1524 to speak with a member of the team.

I'd rather fill out a PDF and send it back.

First Name

Last Name

Phone Number

Address

City

State

ZIP code

Connection to Parkinson's

Year of Diagnosis?

Birth Month

Birth Day

Birth Year

I confirm that I have included a gift to MJFF in my estate plans.

I understand this form does NOT constitute a binding obligation to make a future gift to MJFF.

The value of my/our gift is estimate to be:

The dollar value of my/our estimated gift?

The value of my/our gift is estimated to be the following percentage of my/our estate?

I/We plan to leave this gift through:

Please tell us more about your gift type.

Executor/Trustee Name

Executor/Trustee Phone Number

Financial Advisor Name

Financial Advisor Phone Number

Would you like to be listed as a member of the Legacy Circle in The Michael J. Fox Foundation Annual Report?

Please list my name as:

I would like to receive news and resources from The Michael J. Fox Foundation.

Contact Information

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