UsTOO International Prostate Cancer Education and Support Network: Survey

Question - Not Required - Check as many that apply:

	I have included Us TOO International in my will
	I have named Us TOO International as a primary or joint beneficiary on my life insurance policy
	I have designed Us TOO International as a beneficiary on a retirement account
	I am providing Us TOO International with a gift of stock/securities

Your Name/Name of Bequestor:

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Name:

Title	First Required	Middle Required	Last Required	Suffix

*

Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

Country:

*

Phone Number: Required

Yes, I would like to receive e-mail from Us TOO International Prostate Cancer Education and Support Network

Yes, I would like to receive postal mail from Us TOO International Prostate Cancer Education and Support Network

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Please provide the names and contact information of those assisting you with your planned gifts:

Attorney:

Name:

First Required	Middle Required	Last Required

Email:

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

Country:

Phone Number:

Employer:

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Financial Advisor:

Name:

First Required	Middle Required	Last Required

Email:

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

Country:

Phone Number:

Employer:

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Question - Not Required - Other advisor or family member contact: Family member
Attorney
Financial Advisor
Other

Question - Not Required - If other, please specify relationship:

-

Name:

First Required	Middle Required	Last Required

Email:

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

Country:

Phone Number:

Employer:

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Thank you for providing Us TOO International with your legacy gift. Your contribution will help thousands of men and their families find information and support in their prostate cancer treatment and survivorship journey.

Us TOO Planned Gifts