The PolioPlus Society
District 5730
 
My Personal Commitment:

As a Rotarian, I recognize my personal privilege and responsibility to be able to share in Rotary’s effort to stamp out Polio worldwide.

I hereby commit, by filling out this form, to donate $100 or more, yearly, to the PolioPlus program of The Rotary Foundation. As such, I will become a member of the District 5730 “PolioPlus Society.” Until the last child is immunized, Polio is just a plane ride away from me, my friends and my family.
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As a $100.00 or more contribution, marked specifically for the PolioPlus Fund, you will receive:
  1. Matching Paul Harris Points (PLUS dollars matched 2 to 1 by The Bill and Melinda Foundation)
  2. A unique PolioPlus Society Pin
  3. A PolioPlus Wrist Band
  4. Become a member of the District Polio Plus Society
Requirement: Your Club President, Club Secretary, Club Treasurer, or Club Rotary Foundation Chair must complete The Rotary Foundation Contribution Form (123 EN- 1013),  marked specifically to the PolioPlus Fund and mail it to The Rotary Foundation with your contribution. OR you can specify a direct gift at www.rotary.org – log in to your My Rotary account and click DONATE. Specify PolioPlus for your gift.

Once this form with your commitment is received, your pin and wrist band will be mailed to you.

Thank you.
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By Checking the box, I commit to contribute $100.00 or more, yearly, to the PolioPlus Program of The Rotary Foundation:
  
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