Donation Request Form
Rotary Club of Plattsburgh Sunrise
Date Of Request
-
Month
-
Day
Year
Date
ORGANIZATION INFORMATION
Name
Website
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Sunrise Rotary Past Support
Yes
No
I'm not sure
If yes; when & amount.
INDIVIDUAL CONTACT INFORMATION
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
PROJECT DESCRIPTION • Include the exact dollar amount of contribution if applicable and provide additional documentation if necessary:
Means of Recognizing Rotary:
Additional Information (optional)
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Are you willing to speak about your organization at a meeting?
Yes
No
Maybe
Please note the Small Contributions Committee meets on a quarterly basis. It could take up to three months to receive a decision.
Plattsburgh Sunrise Rotary Club • PO BOX 1183, Plattsburgh, NY 12901
PlattsburghSunriseRotary.org
Meetings 7:30 AM • PSUC Au Sable Hall, or on Zoom. See our website for the meeting schedule. THANK YOU!
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