Bertrand Society Enrollment Form
By completing this form you signify your intention to name Bucknell University as a beneficiary of your estate and your wish to become a member of the Bertrand Society, which honors those who have made legacy gifts to Bucknell.

Informing us of your plans allows us to thank you during your lifetime, and ensures your legacy gift, once received, will be used according to your wishes. We understand that your plans are subject to change depending on personal and economic circumstances, therefore this form is not intended to be a legally binding pledge. The information you provide will remain confidential.

(first name, last name)
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Class Year:
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City, State, Zip:
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I qualify for Bertrand Society membership on the following basis:
Please enter the current estimated dollar value of your gift:
Informing Bucknell of the intended amount of your gift is optional and will not be published.
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Please describe how you would like Bucknell to use your gift:
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