LifeSiteNews.com, Inc.4 Family Life LaneFront Royal, VA 22630

Life Insurance Commitment

I (we),_____________________________________, hereby donate to Human Life Interna-tional, a life insurance gift that I (we) have established to benefit HLI. I (we) have verified my (our) gift by attaching a copy of the life insurance policy and informa-tion regarding net cash surrender value of the policy at the time of the gift as well as pertinent ongoing terms (premium amounts, due dates, etc.) I (we) under-stand that I (we) may, at my (our) discretion, fulfill this commitment during my

Date Gift was Established:

Full Name:

Signature: Date:

Address: City: State: Zip:

Date of Birth:

Email:Phone:

SS#:

Thank you for your interest in the future of LifeSiteNews!

Jon Fidero, Donor Relations Directorjfidero@lifesitenews.com888-678-6008 x923

Initial Gift Value:

Policy issued through:

This gift to LifeSiteNews is irrevocable.

I want my gift to benefit LifeSiteNews where the need is greatest.

a life insurance gift that I (we) have established to benefit the LSN.