Legacy Society Membership Form

Donor Name (First & Last Name) *

Organization (if applicable):

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Phone Number *

Email Address *

I/we pledge to contribute the following amount annually in support of the Xcel Legacy Society, with a minimum annual contribution of $10,000: *

Duration of Pledge Commitment: *

Preferred Method of Payment: *

Would you like to be invoiced annually? *

First Payment Date *

Name(s) to be listed for recognition purposes: *

If you prefer to remain anonymous, enter N/A.

By entering my name below, I/we affirm our commitment to join the Xcel Legacy Society and support its mission with the pledge outlined above. *

Date *

Security Challenge