D6560 District Newsletter Article Submission

Rotary District 6560 Polio Plus Society Pledge Form

Charter Membership Deadline 12-31-23
As a Rotarian and supporter of Polio Eradication, Rotary's Number One Priority, I wish to participate in the Countdown to History as a member of the

DISTRICT 6560 POLIOPLUS SOCIETY.

STEP 1: Make a decision on your contribution amount (Minimum of $100/annually).

STEP 2: Make your contribution to the PolioPlus Fund of the Rotary Foundation. Save a copy of your receipt for your gift or enrollment for recurring giving in Rotary Direct.

STEP 3: Complete this form and attach your receipt from STEP 2.

RECOGNITION: Live presentation at a club meeting of your PolioPlus Society certificate and lapel pin. Your contribution also qualifies for Paul Harris Recognition Points and will be matched 2:1 by the Bill and Melinda Gates Foundation.
$100 USD per year (minimum amount to become a D6560 PolioPlus Society member).Other
STEP 2: How to Make Your Contribution to the PolioPlus Fund of the Rotary Foundation
STEP 3: COMPLETE THE FORM
Name of Donor*

First NameLast Name
Email*
example@example.com
Preferred Phone*

Area CodePhone Number
Rotary Club of*
Please list name/s for recognition exactly how you would like to see it/them.*
Date of contribution*

MonthDayYear
Date
Upload Receipt from STEP 2: PDF, JPEG or GIF of the receipt for contribution-Please DO NOT send a copy of your check. Contact District PolioPlus Chair, Ginger Scott with questions (jrscott2688@gmail.com)*

Browse Files
Receipt should be the confirmation from your gift made on https://my.rotary.org/en/donate Cancelof
Additional Information
Should be Empty:

Rotary District 6560 Polio Plus Society Pledge Form