Cleveland Museum of Natural History

To enroll in the Clark Society Please fill out this form and mail to:

Sheryl Hoffman
The Cleveland Museum of Natural History
1 Wade Oval Drive, University Circle
Cleveland, Ohio 44106-1767

Marie Odendkirk Clark Society Membership Application

I am/we are pleased to accept membership in the Clark Society and I/ we hereby enroll. I understand that recognition as a member of the Clark Society and inclusion in the associated activities is based on my providing the following information:

I have included The Cleveland Museum of Natural History in my will or trust.
I have established an income producing gift plan for the benefit of The Cleveland Museum of Natural History (such as a gift annuity, charitable remainder trust, or charitable lead trust).
I have made other estate provisions naming The Cleveland Museum of Natural History as a beneficiary (such as an insurance policy or IRA).

Please briefly describe your planned gift for the Museum and the purpose for which it is to be used (such as the Museum’s general purposes).

Name(s)

Yours

Additional Name (if this is a joint gift)

Address

Street	Apt/Suite

City	State	ZIP

E-mail Address

Home Phone

Birth Date(s)

Yours	Other's

I/We would be pleased to be included in any published listing of Clark Society members. My/our names should be listed as above. The terms of the gift will remain confidential.
I/We prefer not to be listed, but will accept other benefits of membership.

Signature/Date:
Signature/Date:

Date: