Combined Contribution Form
Fill out your form and return it today! Your Name:
STEP 1: Annual gift to: Seattle Rotary Service Foundation / STEP 2: Annual gift to: Rotary International Foundation (TRF)
GIFT LEVEL:
¨ $1,000
Contributors who give $1,000 or more in a given year are recognized as members of the Pinkham and Skeel Circle of Service Society and enjoy a June reception. / ¨ $400
Minimum gift for Seattle #4 members. / ¨ Other
$______
¨ I’m a
Young Rotary Leader / GIFT LEVEL:
¨ $100
A gift of $100 every year qualifies you as a Paul Harris Sustaining Fellow. / ¨ $500
A gift of $500 or more in a given year also includes a special reception. / ¨ $1,000 / ¨ Other
$______
èDid you know? You earn a Paul Harris Fellow for every $1,000 in gifts you make to Rotary International (over a single year or multiple years).
PAYMENT METHOD:
¨ Check #1 (payable to Seattle Rotary Service Foundation).
¨ Credit Card: I authorize a charge of $______to my credit card (below).
(Your tax acknowledgment will come from SRSF.) / PAYMENT METHOD:
¨ Check #2 (payable to Rotary International/TRF).
¨ Credit Card: I authorize a charge of $_____to my credit card (below).
(Your tax acknowledgement will come directly from Rotary International.)
RI Member # ______. (Seattle #4 staff will complete.)
CREDIT CARD INFORMATION: ¨ Visa ¨MasterCard ¨American Express
Card # Exp. Date.
Name as shown on card:
Card Billing Address: City:
Signature of Card Holder: State: ZIP:
Return your form and checks to Sam Thompson () 1215 4th Avenue, Seattle, WA 98161 206-623-0023
Seattle Rotary Service Foundation and to Rotary International (TRF) contributions are tax-deductible under Section 501 (c)(3) of the IRS tax code.
SRSF 2012 COMBINED DONATION FORM