American Diabetes Association: Summit Circle Enrollment

Enrollment Form

Question - Not Required - I am committed to the prevention and cure of diabetes and to improving the lives of all people affected by diabetes. Therefore, I have established a lasting legacy to the American Diabetes Association and/or the ADA Research Foundation by remembering the Association in the following way(s):

	Will
	Living Trust
	Charitable Remainder Trust
	Charitable Lead Trust
	Charitable Gift Annuity
	Retirement Plan
	Life Insurance Policy
	Other (see below)

Question - Not Required - If "Other" selected, please explain:

Question - Not Required - Please send information on how to make a gift to the American Diabetes Association through a:

	Bequest in a Will or Trust
	Charitable Gift Annuity
	Life Insurance Beneficiary
	Retirement Fund Beneficiary
	Charitable Remainder Trust
	Charitable Lead Trust
	Donor Advised Fund

Contact Information

Please enter the following contact information:

Name:

Title	First Required	Middle Required	Last Required

E-mail:

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Country: Required

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from American Diabetes Association.

Remember me. What's this?

Question - Not Required - What prompted you to explore our planned giving pages?

	American Diabetes Association Home Page
	American Diabetes Association Ad
	Other (please see below)

Question - Not Required - If "Other" selected, please explain:

This letter of intent is not a legal obligation and may be changed at the donor’s discretion.

If you prefer, you may also download and mail the Summit Circle Enrollment Form. If you do not have Adobe Acrobat, it can be downloaded for free at Adobe Acrobat. Please mail the completed form to:

American Diabetes Association
Attn: Individual Giving Department
1701 N. Beauregard Street
Alexandria, VA 22311

Please contact the Individual Giving office at 1-888-700-7029 or giving@diabetes.org with any questions.

American Diabetes Association 1701 North Beauregard Street Alexandria, VA 22311 1-800-DIABETES (800-342-2383)

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