World's Largest Polio Walk Donation Form

Your Name

First NameLast Name

If you are a Rotarian, please enter your Rotary ID # if you know it.

Rotary ID#

Rotary Club Name

Rotarians - select your club. If you are not a Rotarian, please select a club to credit.

Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Phone Number

Area CodePhone Number

Comments

The Rotary District 6440 Charitable Fund is a registered 501(c)(3) organization and has been established to accept donations to fund charitable and educational activities developed and sponsored by Rotary District 6440, the individual Rotary Clubs in Rotary District 6440, and The Rotary Foundation of Rotary International. Gifts are deductible to the full extent allowable under IRS regulations. FEIN 36-4831206. A copy of our IRS 501(c)(3) determination letter is available upon request to 501c3@rotary6440.org.

Contributions by check - please click button below to Print Form, and mail a printed copy with your check to Rotary District 6440 Charitable Fund, Inc., P.O. Box 90, Deerfield IL 60015. Indicate World's Largest Polio Walk in the memo line of your check. Qualified Charitable Donations (QCD) from an Individual Retirement Account (IRA) must be made by check payable to the Rotary District 6440 Charitable Fund.

Contributions by PayPal including credit and debit cards - please click button below to Print Form for your records, enter your donation amount, and then click Submit to enter credit card information. At this time, Rotary District 6440 is covering the credit card fees.

Donation Amount

USDDescription

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.