Archangel Society Membership Form
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Welcome to the <strong>Archangel</strong> <strong>Society</strong> of Mercy Home for Boys & Girls<br />
By naming Mercy Home in your estate plans and becoming a member of the <strong>Archangel</strong> <strong>Society</strong>, you<br />
ensure our children and families have the tools needed to build healthy, productive lives. Thank you<br />
for keeping our kids in your heart and Mercy Home in your will, trust, or other estate plan.<br />
Please complete the information below and return to the Mercy Home Philanthropy team.<br />
Dear Father Scott,<br />
ARCHANGEL SOCIETY MEMBERSHIP FORM<br />
I (we) have remembered Mercy Home for Boys & Girls with a legacy gift in my (our) estate plan.<br />
The current value of this legacy gift is approximately $_________________________, and will come<br />
through the following vehicle(s):<br />
Will<br />
Trust<br />
IRA or Retirement plan<br />
Life insurance policy<br />
Donor-advised fund<br />
Other ___________________________________________<br />
Contact information:<br />
Name____________________________________________________________<br />
Address__________________________________________________________<br />
City, State, Zip____________________________________________________<br />
Date of Birth_____________________________________________________<br />
Phone number____________________________________________________<br />
Email____________________________________________________________<br />
Emergency Contact information:<br />
Name____________________________________________________________<br />
Address__________________________________________________________<br />
City, State, Zip____________________________________________________<br />
Date of Birth_____________________________________________________<br />
Phone number____________________________________________________<br />
Email____________________________________________________________
Becoming an <strong>Archangel</strong> in 2022 Allows You to Make a Bigger<br />
Difference—Today and Tomorrow<br />
By confirming your legacy gift this year, you will automatically join Mercy Home’s Legacy<br />
Challenge. A group of generous donors will match 10% of the current value of your legacy gift<br />
(up to $10,000) to help kids in need today. Please choose which program you would like these<br />
matching funds to support:<br />
Boys Home Programs<br />
Girls Home Programs<br />
Community Care Programs<br />
Wherever it’s needed most<br />
Signature(s)________________________________________________ Date_________________________<br />
Signature(s)________________________________________________ Date_________________________<br />
Notes<br />
The information contained in this membership application is for internal Office of Advancement use only and<br />
not for public disclosure or distribution. None of the information shared on this form is legally binding and<br />
can be changed if needed.<br />
ARCHANGEL SOCIETY MEMBERSHIP FORM<br />
Our legal name: “Mission of Our Lady of Mercy, Inc.”<br />
Our Tax ID number: 36-2171726 (enter this in place of a Social Security Number)<br />
Our mailing address:<br />
Mission of Our Lady of Mercy, Inc.<br />
1140 W Jackson Blvd<br />
Chicago, IL 60607<br />
For more details, visit MercyHome.org/PlannedGiving<br />
Call 1-800-378-8266 or email plannedgift@mercyhome.org<br />
1140 West Jackson Boulevard – Chicago, IL 60607 – 1-800-378-8266
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