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The RNH Grace Dodge Society Pledge Form
Name: _______________________________________________________
Address: _____________________________________________________
City:_________________________ State:________ Zip:______________
q I/We have remembered Riverdale Neighborhood House in my/our will or estate plans and wish to be recognized as a member of the Grace Dodge Legacy Society.
Please list donor(s’) name(s) as:
______________________________________________________
q I/We have remembered Riverdale Neighborhood House in my/our will or estate plans but wish not to be listed in your materials.
Signature:__________________________________Date:_____________
This gift is:
q Unrestricted
q Restricted for _____________________
Please mail or fax this form to:
Legacy Society
RNH
5521 Mosholu Avenue
Bronx, NY 10471
fax: 718-884-1645
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