Contact Information

Name as you would like it listed in the TRLS:

First

Last

Phone

Street Address

Zip

City

State

State Policy Network may include my (and, if applicable, my spouse's) name in the Thomas Roe Legacy Society listings. (Neither amount nor designation, if provided, will be included on the listing.)

I agree to have my name listed

I am honored to be included in the Thomas Roe Legacy Society; however, I prefer to remain anonymous. Please do not include my/our name in the Thomas Roe Legacy Society listings.

I prefer to remain anonymous

Gift Information

Providing the following information is optional. We invite you to share additional details about your estate provision, assuring you that all information will remain strictly confidential.

Estimated value of gift

Is this gift contingent, or is there other information we should be aware of with respect to your plans?

Thank you again for your support! We are glad to work with you to restore the necessary balance of power between the federal government and the states. If you have any questions about this form or your membership in the Thomas Roe Legacy Society, contact Angela Chapman at legacy@spn.org or your SPN contact.