Trf Memorial Or Tribute Gift Form
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1MEMORIAL OR TRIBUTE GIFT FORM
Memorial and Tribute Contributions can also be made at
(Select
gift options
on step 3 to enter memorial/tribute information)
A gift to The Rotary Foundation for a loved one is a meaningful way to honor or memorialize that person. Tribute gifts
can be a perfect birthday, wedding, or holiday gift for the person who has everything.
When you make a tribute or memorial gift, The Rotary Foundation will send a letter to the recipient or the recipient’s
family to let them know about your gift. The amount of your gift is not disclosed. We also will send an acknowledgment
to you as the donor. You will receive a separate tax receipt for gifts above US$25.
ENCLOSED IS MY GIFT IN THE AMOUNT OF:
US$50
US$100
US$250
US$500
US$1,000
Other___________
If you are giving $1,000 and intend to name the honoree/decedent a Paul Harris Fellow,
please use The Rotary Foundation Contribution Form, 123-EN, available at
DESIGNATION/PURPOSE (Check One):
Annual Fund
PolioPlus
Endowment Fund
DONOR OF CONTRIBUTION AND HONOREE/DECEDENT INFORMATION
In Memory of
or In Honor of
Honoree’s ID (if known)_________________________for the occasion (optional)
Donor Name
Donor ID (if known)
Address
City
State/Prov
Postal Code
Country
E-mail
Phone
Please credit the Rotary Club of _________________________________________________District
PLEASE SEND NOTIFICATION OF THIS CONTRIBUTION TO THE FAMILY OR INDIVIDUAL NAMED BELOW
Name
Address
City
State/Prov
Postal Code
Country
How would you like your name(s) printed on the Notification Letter?
MAIL CHECKS TO (USA):
MAIL CHECKS TO: (CANADA):
QUESTIONS:
The Rotary Foundation
The Rotary Foundation (Canada)
Rotary Support Center
14280 Collection Center Drive
c/o 911600,
1-866-9Rotary
Chicago, Il 60693 USA
PO Box 4090, STN A
Toronto, ON M5W 0E9
Canada
Rev. March 2014
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